Healthcare Provider Details

I. General information

NPI: 1265505978
Provider Name (Legal Business Name): RACHEL MCKALE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 07/15/2024
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3998 RED LION RD STE 219
PHILADELPHIA PA
19114-1440
US

IV. Provider business mailing address

1101 MARKET ST FL 19
PHILADELPHIA PA
19107-2926
US

V. Phone/Fax

Practice location:
  • Phone: 215-456-6600
  • Fax: 215-254-2599
Mailing address:
  • Phone: 215-481-6836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA052739
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: