Healthcare Provider Details

I. General information

NPI: 1952327413
Provider Name (Legal Business Name): REBECCA HOHLE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS REBECCA O'BRIEN

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 04/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 CHURCH ST
SARATOGA SPRINGS NY
12866-1046
US

IV. Provider business mailing address

53 SPRING ST
SARATOGA SPRINGS NY
12866-3227
US

V. Phone/Fax

Practice location:
  • Phone: 518-587-1141
  • Fax:
Mailing address:
  • Phone: 518-587-1141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number011249
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number011249
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: