Provider Demographics
NPI:1285797134
Name:HAFER, REBECCA LOUISE (PA-C)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LOUISE
Last Name:HAFER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:LOUISE
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:785 5TH AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-217-4218
Practice Address - Street 1:12 ST PAUL DRIVE
Practice Address - Street 2:SUITE 208
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201
Practice Address - Country:US
Practice Address - Phone:717-217-6072
Practice Address - Fax:717-217-6073
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110003056363A00000X
MDC0004549363A00000X
PA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103287930Medicaid
MDP00993618OtherRR MEDICARE
PAP1024234OtherRR MEDICARE
VAP00844729OtherRR MEDICARE
VA021916V33Medicare PIN
MDP00993618OtherRR MEDICARE
PA227687M0TMedicare PIN
PA103287930Medicaid