Provider Demographics
NPI:1548228497
Name:VACHAROTHONE, RACHOT K (MD)
Entity Type:Individual
Prefix:DR
First Name:RACHOT
Middle Name:K
Last Name:VACHAROTHONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 95970
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-0970
Mailing Address - Country:US
Mailing Address - Phone:801-352-9500
Mailing Address - Fax:801-352-9502
Practice Address - Street 1:10464 S REDWOOD RD
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-8501
Practice Address - Country:US
Practice Address - Phone:801-260-1919
Practice Address - Fax:801-260-1441
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV17627207R00000X
ND14541207R00000X
UT315992-1205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1548228497Medicaid
UT1548228497Medicaid
G44318Medicare UPIN