1992020549 NPI number — REBECCA ERIN STIGALL MD

Table of content: REBECCA ERIN STIGALL MD (NPI 1992020549)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992020549 NPI number — REBECCA ERIN STIGALL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STIGALL
Provider First Name:
REBECCA
Provider Middle Name:
ERIN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992020549
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
FOUR TOWER BRIDGE, 200 BARR HARBOR DRIVE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
WEST CONSHOHOCKEN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19428
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-271-9623
Provider Business Mailing Address Fax Number:
848-240-2812

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1099 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28401-7346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-337-6663
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/06/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  MT200387 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207N00000X , with the licence number: MD50939 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207N00000X , with the licence number: 2017-00657 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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