Provider Demographics
NPI:1679554794
Name:RAUCHER, BETH (MD)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:RAUCHER
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 1:7 WILLOW DRIVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632
Mailing Address - Country:US
Mailing Address - Phone:201-871-0971
Mailing Address - Fax:201-871-3031
Practice Address - Street 1:150 55TH STREET
Practice Address - Street 2:LUTHERAN MEDICAL CENTER
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220
Practice Address - Country:US
Practice Address - Phone:718-630-7300
Practice Address - Fax:718-745-6092
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147144207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00965453Medicaid
NY00965453Medicaid
NY76D031Medicare ID - Type Unspecified