Provider Demographics
NPI:1134145345
Name:BERNACKI, RACHELLE E (MD)
Entity Type:Individual
Prefix:DR
First Name:RACHELLE
Middle Name:E
Last Name:BERNACKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 BINNEY ST.
Mailing Address - Street 2:DEPARTMENT OF PSYCHOSOCIAL ONCOLOGY AND PALLIATIVE CARE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-0001
Mailing Address - Country:US
Mailing Address - Phone:617-632-5310
Mailing Address - Fax:
Practice Address - Street 1:44 BINNEY ST
Practice Address - Street 2:DEPARTMENT OF PSYCHOSOCIAL ONCOLOGY AND PALLIATIVE CARE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6013
Practice Address - Country:US
Practice Address - Phone:617-632-5310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108587207R00000X
MA236811207RH0002X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110080920AMedicaid
MA110080920AMedicaid