Provider Demographics
NPI:1639173313
Name:CONROY, REBEKAH (MD)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:CONROY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 MICHIGAN AVE NW
Mailing Address - Street 2:SUITE 4800
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2916
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:202-476-3732
Practice Address - Street 1:111 MICHIGAN AVE NW
Practice Address - Street 2:SUITE 4800
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2916
Practice Address - Country:US
Practice Address - Phone:202-476-5014
Practice Address - Fax:202-476-3732
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101241790208000000X
DCMD038275208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1190772Medicaid
VA1639173313Medicaid
VA016612V16Medicare PIN