Healthcare Provider Details

I. General information

NPI: 1710706320
Provider Name (Legal Business Name): MEGAN NICOLE REBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2024
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1259 S CEDAR CREST BLVD STE 100
ALLENTOWN PA
18103-6373
US

IV. Provider business mailing address

1259 S CEDAR CREST BLVD STE 100
ALLENTOWN PA
18103-6373
US

V. Phone/Fax

Practice location:
  • Phone: 610-437-4134
  • Fax: 610-433-9690
Mailing address:
  • Phone: 610-437-4134
  • Fax: 610-433-9690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA066128
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: