Healthcare Provider Details

I. General information

NPI: 1548740194
Provider Name (Legal Business Name): REBEKAH A PINKOWSKI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 11/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12720 MCMANUS BLVD STE 307
NEWPORT NEWS VA
23602-4414
US

IV. Provider business mailing address

860 OMNI BLVD STE 303
NEWPORT NEWS VA
23606-4477
US

V. Phone/Fax

Practice location:
  • Phone: 757-872-9797
  • Fax:
Mailing address:
  • Phone: 757-232-8769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110006365
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA059948
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: