Provider Demographics
NPI:1457507238
Name:RAUSCHECKER, MITRA LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:MITRA
Middle Name:LYNN
Last Name:RAUSCHECKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MITRA
Other - Middle Name:LYNN
Other - Last Name:SHAH-HOSSEINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10 CENTER DRIVE MSC 1613
Mailing Address - Street 2:BUILDING 10 CRC RM 6-3940
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20892-0001
Mailing Address - Country:US
Mailing Address - Phone:301-451-0660
Mailing Address - Fax:
Practice Address - Street 1:10 CENTER DRIVE MSC 1613
Practice Address - Street 2:BUILDING 10 CRC RM 6-3940
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-0001
Practice Address - Country:US
Practice Address - Phone:301-451-0660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC150780207R00000X
DCMD038481207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine