Provider Demographics
NPI:1275512279
Name:LEE, REBECCA CLARE (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:CLARE
Last Name:LEE
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 1:1414 PHYSICIANS DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7335
Mailing Address - Country:US
Mailing Address - Phone:910-796-7900
Mailing Address - Fax:910-796-7901
Practice Address - Street 1:955 MERCY LN
Practice Address - Street 2:
Practice Address - City:BOLIVIA
Practice Address - State:NC
Practice Address - Zip Code:28422-9046
Practice Address - Country:US
Practice Address - Phone:910-754-5356
Practice Address - Fax:910-754-5351
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600832207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC147N5OtherBCBS NC
NC8980888Medicaid
NC8980888Medicaid
NC2238720FMedicare PIN