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General NPI Number Information
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NPI Number | 1295711554
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Entity Type | Individual
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Provider Name | REBECCA L. LARK M.D.
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Gender | Female
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Dates
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Enumeration Date | 12/19/2005
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Last Update Date | 08/18/2014
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Provider Practice Location Address
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Address Line | 4539 HEDGEMORE DR SUITE 100
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City | CHARLOTTE
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State | NC
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Zip | 28209-3276
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Country | US
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Telephone | 704-331-9669
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Fax | 704-331-0736
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Provider Business Mailing Address
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Address Line | PO BOX 601888
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City | CHARLOTTE
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State | NC
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Zip | 28260-1888
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Country | US
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Telephone | 704-331-9669
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Fax | 704-331-0736
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 2000-00506
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License Number State | NC
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