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General NPI Number Information
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NPI Number | 1306226121
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Entity Type | Individual
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Provider Name | CLINTON REBELLO MD
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Gender | Male
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Dates
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Enumeration Date | 06/06/2015
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 1865 ROUTE 70 EAST STE 210
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City | CHERRY HILL
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State | NJ
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Zip | 08003-2013
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Country | US
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Telephone | 856-427-4336
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Fax |
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Provider Business Mailing Address
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Address Line | 1865 ROUTE 70 EAST STE 210
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City | CHERRY HILL
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State | NJ
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Zip | 08003-2013
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Country | US
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Telephone | 856-427-4336
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 201003
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License Number State | AK
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Taxonomy #2
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Taxonomy Code | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01078834A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25MA11691000
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License Number State | NJ
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Taxonomy #5
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 01078834A
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License Number State | IN
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Taxonomy #6
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD481798
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License Number State | PA
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