Provider Demographics
NPI:1164678751
Name:WU, REBEKAH RYANNE (MD)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:RYANNE
Last Name:WU
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 1:411 W CHAPEL HILL ST
Mailing Address - Street 2:STE 600
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-3616
Mailing Address - Country:US
Mailing Address - Phone:919-286-0411
Mailing Address - Fax:919-416-5836
Practice Address - Street 1:508 FULTON ST
Practice Address - Street 2:8A CLINIC
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3875
Practice Address - Country:US
Practice Address - Phone:919-286-0411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101245796207R00000X
DCMD038867207R00000X
NC2011-01812207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCP00894780OtherRAILROAD MEDICARE
DCP00894780OtherRAILROAD MEDICARE