Individual provider Active NPI

Lisa K Rakowski, M.D.

  • Pediatric Adolescent Medicine Physician
  • Frederick, MD
National Provider Identifier
1629079355
Registry record updated Jun 18, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
License
D0057220 Issued in MD
Practice address
1475 Taney Ave
Suite 201
Frederick, MD 21702-4747
Phone
(301) 662-0133
Fax
(240) 379-6710
NPI assigned
Aug 3, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine Physician 2080A0000X D0057220 MD Primary

Addresses

Primary practice location

1475 Taney Ave
Suite 201
Frederick, MD 21702-4747

Mailing address

1475 Taney Ave
Suite 201
Frederick, MD 21702-4747
Phone (301) 662-0133

Other identifiers 1

IdentifierTypeStateIssuer
719300900MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
D0057220MDMDPediatric Adolescent Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Trusted Doctors LLC PastSince Feb 25, 2024 Accepting new patients
Trusted Doctors LLC PastSince Feb 25, 2024 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1123027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1276819200000",
    "number": "1629079355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1475 TANEY AVE",
            "address_2": "SUITE 201",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217024747",
            "telephone_number": "301-662-0133",
            "fax_number": "240-379-6710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1475 TANEY AVE",
            "address_2": "SUITE 201",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217024747",
            "telephone_number": "301-662-0133",
            "fax_number": "240-379-6710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAKOWSKI",
        "first_name": "LISA",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-03",
        "last_updated": "2010-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "MD",
            "license": "D0057220",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "719300900",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Frederick, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.