Provider Demographics
NPI:1962427294
Name:RADER, MICHAEL E (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:RADER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 N MIDLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-1912
Mailing Address - Country:US
Mailing Address - Phone:845-348-2198
Mailing Address - Fax:
Practice Address - Street 1:160 N MIDLAND AVE
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-1912
Practice Address - Country:US
Practice Address - Phone:845-348-2198
Practice Address - Fax:845-348-3073
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY128034207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00715568Medicaid
NYMR051A1310Medicare ID - Type Unspecified
NYA63051Medicare UPIN