Provider Demographics
NPI:1467446468
Name:REX, SALLY ANN (DO)
Entity Type:Individual
Prefix:DR
First Name:SALLY ANN
Middle Name:
Last Name:REX
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1343 EASTON AVE
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-2624
Mailing Address - Country:US
Mailing Address - Phone:610-866-0900
Mailing Address - Fax:
Practice Address - Street 1:1343 EASTON AVE
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-2624
Practice Address - Country:US
Practice Address - Phone:610-866-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS002664L207QA0505X
PAOS-002664-L208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA072339Medicare UPIN
PA041901YEBKMedicare PIN
PA041901YUMNMedicare PIN