Provider Demographics
NPI:1063491827
Name:REHBEHN, ERIC P (CRNA)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:P
Last Name:REHBEHN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22217 FAIR GARDEN LN
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20871-4025
Mailing Address - Country:US
Mailing Address - Phone:301-540-6040
Mailing Address - Fax:
Practice Address - Street 1:22217 FAIR GARDEN LN
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:MD
Practice Address - Zip Code:20871-4025
Practice Address - Country:US
Practice Address - Phone:301-540-6040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR111638367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered