Healthcare Provider Details

I. General information

NPI: 1386044212
Provider Name (Legal Business Name): REBECCA ANN BATEMAN MACBRIDE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2014
Last Update Date: 07/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE ST 3 SILVERSTEIN
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

3400 SPRUCE ST 3 SILVERSTEIN
PHILADELPHIA PA
19104-4238
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-3487
  • Fax: 215-349-5534
Mailing address:
  • Phone: 215-662-3487
  • Fax: 215-349-5534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberMA056778
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: