Provider Demographics
NPI:1346256070
Name:WELLS, REBECCA G (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:G
Last Name:WELLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 N 39TH ST
Mailing Address - Street 2:WRIGHT SAUNDERS 218
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-2640
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:215-243-3222
Practice Address - Street 1:51 N 39TH ST
Practice Address - Street 2:WRIGHT SAUNDERS 218
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-2640
Practice Address - Country:US
Practice Address - Phone:215-662-8900
Practice Address - Fax:215-243-3222
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD419756207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001897464Medicaid
PA063951Medicare ID - Type Unspecified
PA001897464Medicaid