MEDICARE: REBECCA L SUMMERLIN MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1497709182
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REBECCA L SUMMERLIN MD PA

Provider Business Mailing Address
First Line	:	PO BOX 2500
Second Line	:
City	:	SHALLOTTE
State	:	NC
Zip	:	28459-2500
Country	:	US
Telephone Number	:	910-575-5242
Fax Number	:	910-575-5245

Provider Business Practice Location Address
First Line	:	120 CAUSEWAY DR SW
Second Line	:	STE 3
City	:	OCEAN ISLE BEACH
State	:	NC
Zip	:	28469-7503
Country	:	US
Telephone Number	:	910-575-5242
Fax Number	:	910-575-5245

Authorized Official
Title or Position	:	SECT/TRES
Name	:	JANET S WHITE
Credential	:
Telephone Number	:	910-575-5242

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	08/22/2020

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