Provider Demographics
NPI:1013941087
Name:DRUASH, REBECCA ANNE (DO)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANNE
Last Name:DRUASH
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 1:11 SAINT ALBANS AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-3623
Mailing Address - Country:US
Mailing Address - Phone:610-356-5500
Mailing Address - Fax:610-356-4553
Practice Address - Street 1:11 SAINT ALBANS AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-3623
Practice Address - Country:US
Practice Address - Phone:610-356-5500
Practice Address - Fax:610-356-4553
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006078L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB64210Medicare UPIN