Provider Demographics
NPI:1235367699
Name:ISKANDAR, REBECCA ALSIP (DO)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:ALSIP
Last Name:ISKANDAR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:LEIGH
Other - Last Name:ALSIP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8614
Mailing Address - Fax:
Practice Address - Street 1:300 SCUFFLETOWN RD
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-7204
Practice Address - Country:US
Practice Address - Phone:864-329-0029
Practice Address - Fax:864-329-8125
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1255207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC012550Medicaid
SCAA77147951Medicare PIN