Provider Demographics
NPI:1396894143
Name:VERGARA, REBECCA B (MD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:B
Last Name:VERGARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:21 LINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-1605
Mailing Address - Country:US
Mailing Address - Phone:973-383-8996
Mailing Address - Fax:973-383-1249
Practice Address - Street 1:175 HIGH ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860
Practice Address - Country:US
Practice Address - Phone:973-579-8715
Practice Address - Fax:973-383-1249
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04857500207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1056905Medicaid
NJE36825Medicare UPIN
NJ1056905Medicaid