Provider Demographics
NPI:1679523534
Name:KEILIN, RACHAEL AUDREY (MD PA)
Entity type:Individual
Prefix:DR
First Name:RACHAEL
Middle Name:AUDREY
Last Name:KEILIN
Suffix:
Gender:F
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2717 SUMMERHILL RD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503
Mailing Address - Country:US
Mailing Address - Phone:903-794-0022
Mailing Address - Fax:903-794-0023
Practice Address - Street 1:2717 SUMMERHILL RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503
Practice Address - Country:US
Practice Address - Phone:903-794-0022
Practice Address - Fax:903-794-0023
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3357208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150050603Medicaid
TX0049MBOtherTX BCBS
OK100845210BMedicaid
TX8AJ747OtherBLUE CROSS BLUE SHIELD
AR146628001Medicaid
AR82479OtherAR BCBS
TX0049MBOtherTX BCBS
TXP00258934Medicare PIN
TX8D1906Medicare PIN