Provider Demographics
NPI:1053501114
Name:O'MALLEY, REBECCA LEIGH (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LEIGH
Last Name:O'MALLEY
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:711 TROY SCHENECTADY RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2442
Mailing Address - Country:US
Mailing Address - Phone:518-213-0478
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:23 HACKETT BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3436
Practice Address - Country:US
Practice Address - Phone:518-262-3341
Practice Address - Fax:518-262-6660
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2023-05-22
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Provider Licenses
StateLicense IDTaxonomies
NY242840208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03236679Medicaid
NY03236679Medicaid
NYJ400021704Medicare PIN