Basic Information
Provider Information
NPI: 1194498014
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: OFILI
FirstName: RACHAEL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3141 CHESTNUT ST
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191042816
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 3141 CHESTNUT ST
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191042816
CountryCode: US
TelephoneNumber: 2158952000
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/27/2021
LastUpdateDate: 07/27/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/27/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP2300XLP-0010451DEY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care

No ID Information.


Home