Provider Demographics
NPI:1740489145
Name:RACKOFF, ANDREW IAN (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:IAN
Last Name:RACKOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 FLEMING ST.
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791-3532
Mailing Address - Country:US
Mailing Address - Phone:828-696-3099
Mailing Address - Fax:828-696-3868
Practice Address - Street 1:1032 FLEMING ST.
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-3532
Practice Address - Country:US
Practice Address - Phone:828-696-3099
Practice Address - Fax:828-696-3868
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN9919207RG0100X
NC2009-00138207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5911922Medicaid
2073391Medicare PIN