Provider Demographics
NPI:1043261746
Name:REBBA, BHAVANA (MD)
Entity Type:Individual
Prefix:MRS
First Name:BHAVANA
Middle Name:
Last Name:REBBA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:BHAVANA
Other - Middle Name:
Other - Last Name:JAKKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:45 HUNT DR
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-6270
Mailing Address - Country:US
Mailing Address - Phone:732-463-0536
Mailing Address - Fax:
Practice Address - Street 1:225 MAY ST
Practice Address - Street 2:SUITE F
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-3266
Practice Address - Country:US
Practice Address - Phone:732-738-6232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07822300207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine