Basic Information
| Provider Information | |||||||||
| NPI: | 1104245331 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KISHTON | ||||||||
| FirstName: | RACHEL | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3737 MARKET STREET | ||||||||
| Address2: | 9TH FLOOR | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191045548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156628777 | ||||||||
| FaxNumber: | 2152434601 | ||||||||
| Practice Location | |||||||||
| Address1: | 3737 MARKET STREET | ||||||||
| Address2: | 9TH FLOOR | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191045548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156628777 | ||||||||
| FaxNumber: | 2152434601 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2014 | ||||||||
| LastUpdateDate: | 06/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | MD466598 | PA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 207Q00000X | MD466598 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.