Provider Demographics
NPI:1720576820
Name:ANASTOS-WALLEN, REBECCA E (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:E
Last Name:ANASTOS-WALLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2317 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-1121
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30 W MONROE ST STE 1200
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-2420
Practice Address - Country:US
Practice Address - Phone:312-733-9730
Practice Address - Fax:773-866-8014
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD473831207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine