Provider Demographics
NPI:1619383312
Name:PIETROFESA, REBECCA J (DO)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:J
Last Name:PIETROFESA
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 1:2310 PATTON RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-9154
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2310 PATTON RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-9154
Practice Address - Country:US
Practice Address - Phone:717-724-6500
Practice Address - Fax:717-724-6510
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT016105207Q00000X
PAOS018598207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103147180Medicaid
PA584215OtherMEDICARE