Provider Demographics
NPI:1497318687
Name:MIFFLIN, RACHEL RONGSTAD (MD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:RONGSTAD
Last Name:MIFFLIN
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 1:15 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-3110
Mailing Address - Country:US
Mailing Address - Phone:608-712-3193
Mailing Address - Fax:
Practice Address - Street 1:40 N MERRIMON AVE STE 117
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-1368
Practice Address - Country:US
Practice Address - Phone:828-348-8232
Practice Address - Fax:855-323-6740
Is Sole Proprietor?:No
Enumeration Date:2019-04-15
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2022-00694208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program