Provider Demographics
NPI:1184623530
Name:EGLEN, REBECCA S (MD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:S
Last Name:EGLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 SINGLETON RIDGE RD
Mailing Address - Street 2:ATTENTION PNS CREDENTIALING
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-9142
Mailing Address - Country:US
Mailing Address - Phone:843-234-6946
Mailing Address - Fax:
Practice Address - Street 1:6010 HIGHWAY 707
Practice Address - Street 2:STE 300
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-7321
Practice Address - Country:US
Practice Address - Phone:843-293-1005
Practice Address - Fax:843-293-1006
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC19497208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC194970Medicaid
F73034Medicare UPIN
SC194970Medicaid