Provider Demographics
NPI:1245486471
Name:REBECCA D LASHBROOK, MD, PC
Entity type:Organization
Organization Name:REBECCA D LASHBROOK, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:AUSTIN
Authorized Official - Last Name:LASHBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-333-8277
Mailing Address - Street 1:280 CLINTON CT
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-3362
Mailing Address - Country:US
Mailing Address - Phone:814-333-8277
Mailing Address - Fax:814-333-6203
Practice Address - Street 1:280 CLINTON CT
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3362
Practice Address - Country:US
Practice Address - Phone:814-333-8277
Practice Address - Fax:814-333-6203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-068906-L291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007502370005Medicaid
PA1007502370005Medicaid