Provider Demographics
NPI:1265420343
Name:THOMAS, REBECCA M (MD)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:M
Last Name:THOMAS
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 1:54 BOLZ COURT
Mailing Address - Street 2:
Mailing Address - City:MT. LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054
Mailing Address - Country:US
Mailing Address - Phone:609-744-8616
Mailing Address - Fax:215-707-2781
Practice Address - Street 1:132 S. 10TH STREET
Practice Address - Street 2:ROOM 285P
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107
Practice Address - Country:US
Practice Address - Phone:215-955-5588
Practice Address - Fax:215-923-9068
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD050559L207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014803110001Medicaid
PA0014803110001Medicaid
F88486Medicare UPIN