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NPI Code Detail

MEDICARE: DR. REBECCA E ANASTOS-WALLEN MD

MEDICARE: DR. REBECCA E ANASTOS-WALLEN 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
1207R00000XInternal Medicine PhysicianMD473831PA

General Provider Information

NPI Number : 1720576820
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. REBECCA E ANASTOS-WALLEN MD
Provider Business Mailing Address
First Line : 2317 SOUTH ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19146-1121
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 30 W MONROE ST STE 1200
Second Line :
City : CHICAGO
State : IL
Zip : 60603-2420
Country : US
Telephone Number : 312-733-9730
Fax Number : 773-866-8014
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2018
Last Update Date : 11/04/2021

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