1447487269 NPI number — RACHEL ANN POLISH DO

Table of content: MONICA JEANETTE RENTERIA (NPI 1801547450)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447487269 NPI number — RACHEL ANN POLISH DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POLISH
Provider First Name:
RACHEL
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1447487269
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 YORKTOWN PLZ
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELKINS PARK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19027-1424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-600-4590
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2700 CLEMENS RD FL 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HATFIELD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19440-4202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-607-7256
Provider Business Practice Location Address Fax Number:
215-258-8999
Provider Enumeration Date:
06/18/2009

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: 207Q00000X , with the licence number:  OS015455 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 30125366 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3881614000 . This is a "KEYSTONE IBC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2709761 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1027206020001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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