Provider Demographics
NPI:1104353028
Name:DAWSON, REBECCA (DO)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:DAWSON
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 1:134 BRIDGETON PIKE STE C
Mailing Address - Street 2:
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062-2616
Mailing Address - Country:US
Mailing Address - Phone:856-507-2783
Mailing Address - Fax:
Practice Address - Street 1:2148 N 2ND ST STE A
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-1304
Practice Address - Country:US
Practice Address - Phone:856-641-6272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-23
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB10634100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty