Provider Demographics
NPI:1497709182
Name:REBECCA L SUMMERLIN MD PA
Entity Type:Organization
Organization Name:REBECCA L SUMMERLIN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECT/TRES
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:S
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-575-5242
Mailing Address - Street 1:PO BOX 2500
Mailing Address - Street 2:
Mailing Address - City:SHALLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28459-2500
Mailing Address - Country:US
Mailing Address - Phone:910-575-5242
Mailing Address - Fax:910-575-5245
Practice Address - Street 1:120 CAUSEWAY DR SW
Practice Address - Street 2:STE 3
Practice Address - City:OCEAN ISLE BEACH
Practice Address - State:NC
Practice Address - Zip Code:28469-7503
Practice Address - Country:US
Practice Address - Phone:910-575-5242
Practice Address - Fax:910-575-5245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2346795Medicare ID - Type UnspecifiedGROUP NUMBER