Provider Demographics
NPI:1497493829
Name:RADABAUGH, REBECCA LYNN (PA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:RADABAUGH
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 1:9611 HESS MILL RD NE
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:OH
Mailing Address - Zip Code:44612-8714
Mailing Address - Country:US
Mailing Address - Phone:330-663-6110
Mailing Address - Fax:
Practice Address - Street 1:3557 EMBASSY PKWY
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-8358
Practice Address - Country:US
Practice Address - Phone:330-670-4242
Practice Address - Fax:330-670-4241
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.007750RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant