Provider Demographics
NPI:1194824052
Name:REBECCA A PROSTKO MD PA
Entity Type:Organization
Organization Name:REBECCA A PROSTKO MD PA
Other - Org Name:MARTIN DOWNS MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PROSTKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-223-6410
Mailing Address - Street 1:938 SW MARTIN DOWNS BLVD
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-2816
Mailing Address - Country:US
Mailing Address - Phone:772-223-6410
Mailing Address - Fax:772-223-0092
Practice Address - Street 1:938 SW MARTIN DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-2816
Practice Address - Country:US
Practice Address - Phone:772-223-6410
Practice Address - Fax:772-223-0092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0052247174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty