Provider Demographics
NPI:1144319351
Name:ABERNATHY, REBECCA E (MD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:E
Last Name:ABERNATHY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:A
Other - Last Name:SHELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:661 UNIVERSITY LN STE A
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:VA
Practice Address - Zip Code:22960-2243
Practice Address - Country:US
Practice Address - Phone:540-661-3025
Practice Address - Fax:540-661-3021
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057178208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010190002Medicaid
VAH75516Medicare UPIN
VA008124U92Medicare PIN