Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | MD045565L | PA |
NPI | 1003876715 |
---|---|
Provider Name | Dr. Mark A Rackish |
First Address | Williamsport, PA 17701-1900 |
Second Address | Williamsport, PA 17701-2647 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2006 |
Last Update Date | 18/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001259522 | (05) | PA |
B29054 | (02) | PA |