Provider Demographics
NPI:1003818436
Name:SOUTHARD, REBECCA E (DPM)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:E
Last Name:SOUTHARD
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 352
Mailing Address - Street 2:
Mailing Address - City:SCITUATE
Mailing Address - State:MA
Mailing Address - Zip Code:02066-0352
Mailing Address - Country:US
Mailing Address - Phone:781-545-9285
Mailing Address - Fax:781-545-9553
Practice Address - Street 1:10 NEW DRIFTWAY
Practice Address - Street 2:SUITE 103
Practice Address - City:SCITUATE
Practice Address - State:MA
Practice Address - Zip Code:02066-4530
Practice Address - Country:US
Practice Address - Phone:781-545-9285
Practice Address - Fax:781-545-9553
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2048213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2316054OtherAETNA
MAY71003OtherB/S
MA0357871Medicaid
MA333403OtherPILGRIM
MA002048OtherTUFTS
MA2700098OtherUNITED HEALTH CARE
MA0000644OtherNEIGHBORHOOD HEALTH PLANS
MA480018778OtherRAILROAD MEDICARE
MAB2081900OtherCIGNA
MAB2081900OtherCIGNA
MA480018778OtherRAILROAD MEDICARE
MAY7500502Medicare PIN