Provider Demographics
NPI:1174622625
Name:THACHIL, RAJEEVE T (MD)
Entity type:Individual
Prefix:DR
First Name:RAJEEVE
Middle Name:T
Last Name:THACHIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20 CREST BLVD
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-3135
Mailing Address - Country:US
Mailing Address - Phone:610-253-4114
Mailing Address - Fax:
Practice Address - Street 1:2111 WASHINGTON BLVD
Practice Address - Street 2:1ST FLOOR
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-3803
Practice Address - Country:US
Practice Address - Phone:610-250-4595
Practice Address - Fax:610-250-4972
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD066297L207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H37961Medicare UPIN