1346895752 NPI number — DR. RACHNA D JAIN PSYD

Table of content: DR. RACHNA D JAIN PSYD (NPI 1346895752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346895752 NPI number — DR. RACHNA D JAIN PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JAIN
Provider First Name:
RACHNA
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346895752
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/03/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20203 GOSHEN RD # 374
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAITHERSBURG
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20879-4000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-389-3459
Provider Business Mailing Address Fax Number:
240-396-5773

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11700 MONTGOMERY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELTSVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20705-1159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-389-3459
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/03/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  03644 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)