Provider Demographics
NPI:1093896417
Name:REBBECCHI, THOMAS A (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:REBBECCHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FEDERAL ST # 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:856-356-4924
Mailing Address - Fax:
Practice Address - Street 1:1 COOPER PLZ
Practice Address - Street 2:COOPER UNIVERSITY EMERGENCY PHYSICIANS
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1461
Practice Address - Country:US
Practice Address - Phone:856-342-2351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA60971207P00000X
NJ25MA10150500207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ010006257 00OtherAMERICHOICE
NJ6708307Medicaid
NJP3549978OtherOXFORD
NJ0880679000OtherAMERIHEALTH/KEYSTONE/IBC
NJ1911779OtherUNITED HEALTHCARE
NJ28444OtherUNIVERSITY HEALTH PLAN
NJ847657OtherAMERIHEALTH PPO/PA BS
NJ5942939OtherCIGNA
NJ60005656OtherHORIZON NJ HEALTH
NJ3498505OtherAETNA
NJ6708307Medicaid
NJ60005656OtherHORIZON NJ HEALTH
NHF86316Medicare UPIN