1588837553 NPI number — LYUDMILA RAKITA M.D.,P.C.

Table of content: (NPI 1588837553)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588837553 NPI number — LYUDMILA RAKITA M.D.,P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LYUDMILA RAKITA M.D.,P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1588837553
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1342 BELMONT ST
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
BROCKTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02301-4436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-895-9393
Provider Business Mailing Address Fax Number:
508-895-9990

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1342 BELMONT ST
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
BROCKTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02301-4436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-895-9393
Provider Business Practice Location Address Fax Number:
508-895-9990
Provider Enumeration Date:
04/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
RAKITA
Authorized Official First Name:
LYUDMILA
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN/PSYCHIATRIST
Authorized Official Telephone Number:
508-895-9393

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  152341 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3181715 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com