Provider Demographics
NPI:1235432295
Name:RAUCHUT, THOMAS JOHN (CRNP)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOHN
Last Name:RAUCHUT
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 ARDEN LN
Mailing Address - Street 2:
Mailing Address - City:COATESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19320-5619
Mailing Address - Country:US
Mailing Address - Phone:215-260-5817
Mailing Address - Fax:
Practice Address - Street 1:3601 A ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-1043
Practice Address - Country:US
Practice Address - Phone:215-427-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-14
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR193522363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care