Provider Demographics
NPI:1588837553
Name:LYUDMILA RAKITA M.D.,P.C.
Entity Type:Organization
Organization Name:LYUDMILA RAKITA M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LYUDMILA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAKITA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-895-9393
Mailing Address - Street 1:1342 BELMONT ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4436
Mailing Address - Country:US
Mailing Address - Phone:508-895-9393
Mailing Address - Fax:508-895-9990
Practice Address - Street 1:1342 BELMONT ST
Practice Address - Street 2:SUITE 103
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4436
Practice Address - Country:US
Practice Address - Phone:508-895-9393
Practice Address - Fax:508-895-9990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1523412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3181715Medicaid
MAG73618Medicare UPIN
MA3181715Medicaid