Provider Demographics
NPI:1861432841
Name:JONES, REBECCA M (MD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:M
Last Name:JONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 ELLIOT ST
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-3018
Mailing Address - Country:US
Mailing Address - Phone:802-251-0958
Mailing Address - Fax:802-251-6023
Practice Address - Street 1:138 ELLIOT ST
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-3027
Practice Address - Country:US
Practice Address - Phone:802-251-0958
Practice Address - Fax:802-251-6023
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420010026207N00000X
MA152559207N00000X
MA9808207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH01Y003121VT01OtherBC/BS NH
VT29022OtherBC/BS VT
VTOVN2257Medicaid
MAJOJ17545OtherBC/BS MA
VTOVN2257Medicaid
VTBX9578Medicare PIN
VT29022OtherBC/BS VT
VT29022OtherBC/BS VT
NH30009781Medicaid