MEDICARE: DR. RACHEL J KUTTICHIRA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	140888	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	AP248	OTHER	OXFORD
3	125139	OTHER	AETNA

General Provider Information

NPI Number	:	1104988641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RACHEL J KUTTICHIRA MD

Provider Business Mailing Address
First Line	:	1908 N GRAND AVE
Second Line	:	RACHEL J KUTTICHIRA MD PC BALDWIN PEDIATRIC CARE
City	:	BALDWIN
State	:	NY
Zip	:	11510
Country	:	US
Telephone Number	:	516-377-4120
Fax Number	:	516-377-7746

Provider Business Practice Location Address
First Line	:	1908 N GRAND AVE
Second Line	:	RACHEL J KUTTICHIRA MD PC BALDWIN PEDIATRIC CARE
City	:	BALDWIN
State	:	NY
Zip	:	11510
Country	:	US
Telephone Number	:	516-377-4120
Fax Number	:	516-377-7746

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	07/08/2007

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