Provider Demographics
NPI:1235106113
Name:LINGENFELTER, REBECCA H (PA C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:H
Last Name:LINGENFELTER
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 LANCASTER BLVD
Mailing Address - Street 2:PO BOX 2028
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-3562
Mailing Address - Country:US
Mailing Address - Phone:717-691-3755
Mailing Address - Fax:717-691-3834
Practice Address - Street 1:175 LANCASTER BLVD
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-3562
Practice Address - Country:US
Practice Address - Phone:717-691-3755
Practice Address - Fax:717-691-3834
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002505L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P19769Medicare UPIN
PA043951KCUMedicare PIN