Provider Demographics
NPI:1487942736
Name:KACZYNSKI, RACHEL ELLEN (DO)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:ELLEN
Last Name:KACZYNSKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:RACHEL
Other - Middle Name:ELLEN
Other - Last Name:BEVERIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-0813
Practice Address - Street 1:2130 NE LOOP 410 STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-4660
Practice Address - Country:US
Practice Address - Phone:210-656-7177
Practice Address - Fax:210-656-3687
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY267637208600000X
OH34.0149602086X0206X
TXT21912086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery