Provider Demographics
NPI:1356396147
Name:HUMMEL, RACHEL L (DO)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:L
Last Name:HUMMEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 W STREETSBORO ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-2876
Mailing Address - Country:US
Mailing Address - Phone:330-344-7650
Mailing Address - Fax:330-342-4399
Practice Address - Street 1:82 W STREETSBORO ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236
Practice Address - Country:US
Practice Address - Phone:330-344-7650
Practice Address - Fax:330-342-4399
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-008327207QS0010X, 207Q00000X
NC2006-00100207QS0010X
IN02003576A207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2511946Medicaid
OH1841239274OtherPARTNERS PHYSICIAN GROUP TYPE 2 NPI #
OH2551671OtherPARTNERS PHYSICIAN GROUP MEDICAID GROUP #
OH9338635OtherPARTNERS PHYSICIAN GROUP MEDICARE GROUP #
I00464Medicare UPIN
OH2511946Medicaid