Provider Demographics
NPI:1104988641
Name:KUTTICHIRA, RACHEL J (MD)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:J
Last Name:KUTTICHIRA
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1908 N GRAND AVE
Mailing Address - Street 2:RACHEL J KUTTICHIRA MD PC BALDWIN PEDIATRIC CARE
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510
Mailing Address - Country:US
Mailing Address - Phone:516-377-4120
Mailing Address - Fax:516-377-7746
Practice Address - Street 1:1908 N GRAND AVE
Practice Address - Street 2:RACHEL J KUTTICHIRA MD PC BALDWIN PEDIATRIC CARE
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510
Practice Address - Country:US
Practice Address - Phone:516-377-4120
Practice Address - Fax:516-377-7746
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY140888208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY004710Medicaid
AP248OtherOXFORD
125139OtherAETNA
A61990Medicare UPIN