Provider Demographics
NPI:1518586502
Name:REPH, ANNA (DO)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:REPH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:684 AVON BELDEN RD
Mailing Address - Street 2:STE A
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-5219
Mailing Address - Country:US
Mailing Address - Phone:440-737-3646
Mailing Address - Fax:
Practice Address - Street 1:684 AVON BELDEN RD
Practice Address - Street 2:STE A
Practice Address - City:AVON LAKE
Practice Address - State:OH
Practice Address - Zip Code:44012
Practice Address - Country:US
Practice Address - Phone:440-737-3646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-10
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.016490207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine