Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 57281 | WI |
N | 207Q00000X | Family Doctor | LP001411 | RI |
N | 207Q00000X | Family Doctor | MD13465 | RI |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | LAJ00004 | RI |
NPI | 1023271475 |
---|---|
Provider Name | Gregory Rachu |
First Address | Providence, RI 02903-4923 |
Second Address | West Allis, WI 53214-4734 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2008 |
Last Update Date | 24/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002198101 | MEDICARE PTAN (01) | RI |
1023271475 | (05) | WI |
GR85523 | (05) | RI |