Provider Demographics
NPI:1508266479
Name:REBECCA WARKOL MD LLC
Entity Type:Organization
Organization Name:REBECCA WARKOL MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:WARKOL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-637-5406
Mailing Address - Street 1:8 W END AVE
Mailing Address - Street 2:
Mailing Address - City:OLD GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06870-1642
Mailing Address - Country:US
Mailing Address - Phone:203-637-5406
Mailing Address - Fax:203-637-5408
Practice Address - Street 1:8 W END AVE
Practice Address - Street 2:
Practice Address - City:OLD GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06870-1642
Practice Address - Country:US
Practice Address - Phone:203-637-5406
Practice Address - Fax:203-637-5408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-28
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT110010324Medicare UPIN