Provider Demographics
NPI:1629189337
Name:NOLL, RACHEL I (MD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:I
Last Name:NOLL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:PO BOX 10744
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33757-8744
Mailing Address - Country:US
Mailing Address - Phone:727-532-0002
Mailing Address - Fax:
Practice Address - Street 1:2044 TRINITY OAKS BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-4409
Practice Address - Country:US
Practice Address - Phone:727-375-0601
Practice Address - Fax:813-635-7862
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME96740207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277656100Medicaid
FLP00368108OtherRAILROAD MEDICARE NUMBER
FL277656100Medicaid
FLU8349ZMedicare PIN