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General NPI Number Information
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NPI Number | 1316318777
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Entity Type | Individual
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Provider Name | REBECCA OLIVER PA
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Gender | Female
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Dates
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Enumeration Date | 10/12/2015
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 700 GEIPE RD STE 265
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City | BALTIMORE
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State | MD
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Zip | 21228-4152
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Country | US
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Telephone | 410-747-7100
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Fax | 410-788-7387
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Provider Business Mailing Address
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Address Line | 9601 PULASKI PARK DR STE 416
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City | MIDDLE RIVER
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State | MD
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Zip | 21220-1409
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Country | US
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Telephone | 410-933-5678
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Fax | 410-238-7451
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110-005121
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C06480
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License Number State | MD
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