Provider Demographics
NPI:1053305219
Name:LASHBROOK, REBECCA D (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:D
Last Name:LASHBROOK
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 1:280 CLINTON CT
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-3362
Mailing Address - Country:US
Mailing Address - Phone:814-333-8277
Mailing Address - Fax:814-333-6203
Practice Address - Street 1:280 CLINTON CT
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3362
Practice Address - Country:US
Practice Address - Phone:814-333-8277
Practice Address - Fax:814-333-6203
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-02
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-068906-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018504030004Medicaid
PA050413X8VMedicare PIN
PAG61730Medicare UPIN