Provider Demographics
NPI:1649245465
Name:VALLA, REBECCA S (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:S
Last Name:VALLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:915 WEST FOURTHSTREET
Mailing Address - Street 2:
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101
Mailing Address - Country:US
Mailing Address - Phone:336-750-0130
Mailing Address - Fax:336-750-0073
Practice Address - Street 1:915 WEST FOURTH STREET
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101
Practice Address - Country:US
Practice Address - Phone:336-750-0130
Practice Address - Fax:336-750-0073
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC357762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC85015OtherB;UECROSSBLUESHIELD
NC2209010BMedicare ID - Type Unspecified
NCE23417Medicare UPIN