Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | MD466413 | PA |
NPI | 1033523691 |
---|---|
Provider Name | Rebecca Jane Fallis |
First Address | Willow Grove, PA 19090-1225 |
Second Address | Abington, PA 19001-3841 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2014 |
Last Update Date | 24/12/2019 |