Provider Demographics
NPI:1619178621
Name:RACKLEY, ANGELA Y (MD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:Y
Last Name:RACKLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 27TH ST STE B06
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2681
Mailing Address - Country:US
Mailing Address - Phone:740-356-8681
Mailing Address - Fax:740-356-1256
Practice Address - Street 1:1711 27TH ST STE 103A
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2654
Practice Address - Country:US
Practice Address - Phone:740-356-6740
Practice Address - Fax:740-356-1274
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0908022084N0400X
OH35-0908022084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2800508Medicaid
KY7100179190Medicaid
KYP00981133OtherRAILROAD MEDICARE
KYK014400Medicare PIN
OH2800508Medicaid
OH4309741Medicare PIN
OH7380191Medicare PIN