Provider Demographics
NPI:1568521656
Name:FORD, REBECCA LEE (ANP)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:LEE
Last Name:FORD
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2 BUCKTHORN LN
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-2966
Mailing Address - Country:US
Mailing Address - Phone:617-816-6262
Mailing Address - Fax:
Practice Address - Street 1:301 NORRISTOWN RD
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-2760
Practice Address - Country:US
Practice Address - Phone:267-609-9724
Practice Address - Fax:215-628-2037
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP021729207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1515Medicaid
SCQ74771Medicare UPIN