Provider Demographics
NPI:1659825685
Name:PANAGOS, REBEKAH (CPM, LM)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:PANAGOS
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 AUBURN AVE
Mailing Address - Street 2:
Mailing Address - City:BROWNS MILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:08015-1946
Mailing Address - Country:US
Mailing Address - Phone:609-321-6181
Mailing Address - Fax:
Practice Address - Street 1:120 AUBURN AVE
Practice Address - Street 2:
Practice Address - City:BROWNS MILLS
Practice Address - State:NJ
Practice Address - Zip Code:08015-1946
Practice Address - Country:US
Practice Address - Phone:609-321-6181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-08
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MW00002500176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife