Provider Demographics
NPI:1770561334
Name:HUME, LARA REBECCA (MD)
Entity type:Individual
Prefix:
First Name:LARA
Middle Name:REBECCA
Last Name:HUME
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 1:1100 TUNNEL ROAD
Mailing Address - Street 2:ASHEVILLE VA MEDICAL CENTER
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28805
Mailing Address - Country:US
Mailing Address - Phone:828-298-7911
Mailing Address - Fax:828-296-4425
Practice Address - Street 1:1100 TUNNEL ROAD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28805-7911
Practice Address - Country:US
Practice Address - Phone:828-298-7911
Practice Address - Fax:828-296-4425
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9901548207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
030455058OtherCRESENT
NC12586OtherBCBS
NC8912486Medicaid
5435417002OtherCIGNA HEALTHCARE
SCN01549Medicaid
110245214OtherRR MEDICARE
030455058OtherHEALTHCARE SAVINGS
0401746OtherUNITED HEALTHCARE
VAD000OtherVA UPIN
C3416OtherMEDCOST
H10408Medicare UPIN
2280091AMedicare ID - Type Unspecified