Provider Demographics
NPI:1740261767
Name:SHORT, RACHEL (MD)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:SHORT
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 1:309 SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-1557
Mailing Address - Country:US
Mailing Address - Phone:859-494-0542
Mailing Address - Fax:
Practice Address - Street 1:309 SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-1557
Practice Address - Country:US
Practice Address - Phone:859-494-0542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2020-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38956207Q00000X, 207RA0401X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00196323OtherRAILROAD MEDICARE
KY64086374Medicaid
KYK016814Medicare PIN
KY64086374Medicaid
KY0074280Medicare ID - Type Unspecified
KYP00196323OtherRAILROAD MEDICARE