Healthcare Provider Details

I. General information

NPI: 1255349114
Provider Name (Legal Business Name): REBECCA R TOMSYCK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 02/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6220 THERMAL RD
CHARLOTTE NC
28211-5630
US

IV. Provider business mailing address

6220 THERMAL RD
CHARLOTTE NC
28211-5630
US

V. Phone/Fax

Practice location:
  • Phone: 704-366-8712
  • Fax:
Mailing address:
  • Phone: 704-366-8712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number31418
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier10454
Identifier TypeOTHER
Identifier StateSC
Identifier IssuerMD
# 2
Identifier31418
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: