Provider Demographics
NPI:1457432874
Name:REBOLI, ANNETTE C (MD)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:C
Last Name:REBOLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:501 FELLOWSHIP RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-3419
Mailing Address - Country:US
Mailing Address - Phone:856-963-3572
Mailing Address - Fax:856-338-9211
Practice Address - Street 1:501 FELLOWSHIP RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-3419
Practice Address - Country:US
Practice Address - Phone:856-963-3572
Practice Address - Fax:856-338-9211
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA62547207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
010003728 00OtherAMERICHOICE
1445508OtherUNITED HEALTH CARE
1023743OtherHORIZON NJ HEALTH
3K6109OtherHEALTHNET
83709OtherAMERIGROUP
17285OtherUNIVERSITH HEALTH PLAN
2837621OtherCIGNA
0828674000OtherAMERIHEALTH, HMO, KEYSTONE, IBC
NJ1825402Medicaid
P405898OtherOXFORD HELATH PAN
533279OtherAETN
802995OtherAMERIHEALTH PPO
533279OtherAETN
1445508OtherUNITED HEALTH CARE
2837621OtherCIGNA