Provider Demographics
NPI:1639120645
Name:RACHLIN, JACOB R (MD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:R
Last Name:RACHLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1101 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5587
Mailing Address - Country:US
Mailing Address - Phone:617-731-8334
Mailing Address - Fax:617-731-8556
Practice Address - Street 1:1101 BEACON ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5587
Practice Address - Country:US
Practice Address - Phone:617-731-8334
Practice Address - Fax:617-731-8556
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2012-08-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA74738204C00000X, 207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAE98557Medicare UPIN