Provider Demographics
NPI:1699017731
Name:HAYWORTH, REBECCA SUE (MD)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:SUE
Last Name:HAYWORTH
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 1:998 S DORSET RD STE 104
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-4748
Mailing Address - Country:US
Mailing Address - Phone:937-332-8843
Mailing Address - Fax:937-332-8982
Practice Address - Street 1:998 S DORSET RD STE 104
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-4748
Practice Address - Country:US
Practice Address - Phone:937-332-8843
Practice Address - Fax:937-332-8982
Is Sole Proprietor?:No
Enumeration Date:2013-03-26
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.127886208100000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0217837Medicaid