Provider Demographics
NPI:1669731642
Name:HOLLIDAY, RACHAEL (MD)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:HOLLIDAY
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 1:2162 N MERIDIAN ST STE B
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1311
Mailing Address - Country:US
Mailing Address - Phone:317-964-0014
Mailing Address - Fax:669-235-7285
Practice Address - Street 1:2162 N MERIDIAN ST STE B
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1311
Practice Address - Country:US
Practice Address - Phone:317-957-2100
Practice Address - Fax:317-957-2120
Is Sole Proprietor?:No
Enumeration Date:2012-05-10
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01076634A207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1669731642Medicaid
IN201097890Medicaid