Provider Demographics
NPI:1588636518
Name:COKER, REBECCA S
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:S
Last Name:COKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 BETHESDA DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-7218
Mailing Address - Country:US
Mailing Address - Phone:252-752-7141
Mailing Address - Fax:252-752-0223
Practice Address - Street 1:300 BETHESDA DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7218
Practice Address - Country:US
Practice Address - Phone:252-752-7141
Practice Address - Fax:252-752-0223
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600453208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8923250Medicaid
NYE31012Medicare UPIN