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1023093812

NPI Code Detail

MEDICARE: REBECCA LYNNE BACZUK MD

MEDICARE: REBECCA LYNNE BACZUK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	0101236813	VA
2	208100000X	Physical Medicine & Rehabilitation Physician	ME153039	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023093812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA LYNNE BACZUK MD

Provider Business Mailing Address
First Line	:	2388 BAYS EDGE AVE
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451
Country	:	US
Telephone Number	:	410-991-4647
Fax Number	:	443-458-7224

Provider Business Practice Location Address
First Line	:	200 N LAKEMONT AVE
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-3273
Country	:	US
Telephone Number	:	407-303-1332
Fax Number	:	407-303-0347

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	02/29/2024

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Directions to “ REBECCA LYNNE BACZUK MD” Practice Location

Language	Start Address	Practice Location

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