Healthcare Provider Details

I. General information

NPI: 1255436689
Provider Name (Legal Business Name): CHRISTOPHER H. RASSEKH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE STREET 5 SILVERSTEIN BUILDING
PHILADELPHIA PA
19104-4206
US

IV. Provider business mailing address

3400 SPRUCE ST 5 SILVERSTEIN BUILDING
PHILADELPHIA PA
19104-4206
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-2777
  • Fax: 304-293-6963
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberMD046601L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: