Basic Information
| Provider Information | |||||||||
| NPI: | 1912153792 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RACHSHTUT | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 FEDERAL ST # 200 | ||||||||
| Address2: | |||||||||
| City: | CAMDEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081031088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563564924 | ||||||||
| FaxNumber: | 8563564793 | ||||||||
| Practice Location | |||||||||
| Address1: | MD ANDERSON CANCER CENTER | ||||||||
| Address2: | 2 COOPER PLAZA | ||||||||
| City: | CAMDEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8556322667 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2008 | ||||||||
| LastUpdateDate: | 05/21/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | MD427270 | PA | N | Other Service Providers | Specialist | 207RX0202X | 25MA08080500 | NJ | N | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | 207RH0003X | 25MA08080500 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | G2680214 | 01 | OXFORD | OTHER | 23-3004350 | 01 | CIGNA | OTHER | RA2100824 | 01 | BLUE SHIELD | OTHER | 1099290 | 01 | KEYSTONE MERCY | OTHER | 23-3004350 | 01 | AMERICHOICE | OTHER | 1022974130001 | 05 | PA | MEDICAID | 0037885000 | 01 | BLUE CROSS/BLUE SHIELD | OTHER | 2157977 | 01 | AETNA | OTHER | 30045 | 01 | HEALTH PARTNERS | OTHER | 522510 | 01 | NJ | HORIZON BLUE CROSS OF NJ | OTHER |