Provider Demographics
NPI:1356471767
Name:BARTHOLOMEW, ANN REBECCA (PA)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:REBECCA
Last Name:BARTHOLOMEW
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 IRIS WAY
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-3885
Mailing Address - Country:US
Mailing Address - Phone:404-667-8370
Mailing Address - Fax:
Practice Address - Street 1:2311 DELANEY AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6012
Practice Address - Country:US
Practice Address - Phone:910-726-3055
Practice Address - Fax:910-762-0778
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH003302363A00000X
MAPA3830363A00000X
NMPA2016-0047363A00000X
VA0110-004577363A00000X
TXPA05207363A00000X
UT11181292-1206363A00000X
NC0010-10190363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0067861Medicaid
OHH062240Medicare PIN