Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 74738 | MA |
Y | 207T00000X | Neurosurgeon | 74738 | MA |
NPI | 1639120645 |
---|---|
Provider Name | Dr. Jacob R Rachlin |
First Address | Brookline, MA 02446-5587 |
Second Address | Brookline, MA 02446-5587 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2006 |
Last Update Date | 16/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E98557 | (02) | MA |