MEDICARE: REBECCA DINGFELDER PH.D.

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	103TC0700X	Clinical Psychologist	2935	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	046EY	OTHER	NC	BCBSNC

General Provider Information

NPI Number	:	1093898249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA DINGFELDER PH.D.

Provider Business Mailing Address
First Line	:	5015 SOUTHPARK DR
Second Line	:	SUITE 200
City	:	DURHAM
State	:	NC
Zip	:	27713-7736
Country	:	US
Telephone Number	:	919-794-5479
Fax Number	:	919-794-5479

Provider Business Practice Location Address
First Line	:	5015 SOUTHPARK DR
Second Line	:	SUITE 200
City	:	DURHAM
State	:	NC
Zip	:	27713-7736
Country	:	US
Telephone Number	:	919-794-5479
Fax Number	:	919-794-5479

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	05/16/2011

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