Healthcare Provider Details

I. General information

NPI: 1467446468
Provider Name (Legal Business Name): SALLY ANN REX D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 12/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1343 EASTON AVE
BETHLEHEM PA
18018-2624
US

IV. Provider business mailing address

1343 EASTON AVE
BETHLEHEM PA
18018-2624
US

V. Phone/Fax

Practice location:
  • Phone: 610-866-0900
  • Fax:
Mailing address:
  • Phone: 610-866-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberOS002664L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberOS-002664-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: