Provider Demographics
NPI:1215399746
Name:FURBY, REBECCA LAUREN
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LAUREN
Last Name:FURBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25404-7542
Mailing Address - Country:US
Mailing Address - Phone:304-724-6343
Mailing Address - Fax:
Practice Address - Street 1:61 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-7542
Practice Address - Country:US
Practice Address - Phone:304-724-6343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-23
Last Update Date:2023-02-08
Deactivation Date:2019-08-21
Deactivation Code:
Reactivation Date:2019-08-30
Provider Licenses
StateLicense IDTaxonomies
390200000X
WV28989208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program