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General NPI Number Information
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NPI Number | 1225387012
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Entity Type | Individual
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Provider Name | MICHAEL A RACKOVER PA-C
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Gender | Male
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Dates
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Enumeration Date | 09/07/2012
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Last Update Date | 09/07/2012
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Provider Practice Location Address
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Address Line | 4201 HENRY AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19144-5409
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Country | US
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Telephone | 215-951-2676
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Fax |
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Provider Business Mailing Address
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Address Line | 557 FRANKLIN WAY
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City | WEST CHESTER
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State | PA
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Zip | 19380-5711
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Country | US
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Telephone | 484-266-0473
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA000744L
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License Number State | PA
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