Provider Demographics
NPI:1720125701
Name:WITHAM, REBECCA S (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:S
Last Name:WITHAM
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Gender:F
Credentials:MD
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Mailing Address - Street 1:255 W LANCASTER AVE
Mailing Address - Street 2:SUITE 237 PAOLI MOB III
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1763
Mailing Address - Country:US
Mailing Address - Phone:484-565-1212
Mailing Address - Fax:484-565-8881
Practice Address - Street 1:255 W LANCASTER AVE
Practice Address - Street 2:SUITE 237 PAOLI MOB III
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1763
Practice Address - Country:US
Practice Address - Phone:484-565-1212
Practice Address - Fax:484-565-8881
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2019-02-05
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Provider Licenses
StateLicense IDTaxonomies
PAMD036577E208200000X, 2083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE67421Medicare UPIN
PAE67421Medicare UPIN
PA440771OtherMLHC MEDICARE AA ACCOUNT