Basic Information
Provider Information
NPI: 1598159964
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FLYNN
FirstName: RACHEL
MiddleName:  
NamePrefix:  
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Credential:  
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Mailing Information
Address1: 2100 MACK BLVD
Address2:  
City: ALLENTOWN
State: PA
PostalCode: 181035622
CountryCode: US
TelephoneNumber: 4848840617
FaxNumber: 4848840628
Practice Location
Address1: 1200 S CEDAR CREST BLVD
Address2:  
City: ALLENTOWN
State: PA
PostalCode: 181036202
CountryCode: US
TelephoneNumber: 6104027632
FaxNumber: 6104027600
Other Information
ProviderEnumerationDate: 03/24/2015
LastUpdateDate: 06/11/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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IsSoleProprietor: Y
IsOrganizationSubpart:  
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AuthorizedOfficialCredential:  
NPICertificationDate: 06/11/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
2080N0001XMD463910PAY Allopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine

No ID Information.


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