MEDICARE: REBECCA M LANCASTER P.A.

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	363AM0700X	Medical Physician Assistant	103808	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548222755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA M LANCASTER P.A.

Provider Business Mailing Address
First Line	:	PO BOX 275
Second Line	:
City	:	KENLY
State	:	NC
Zip	:	27542-0275
Country	:	US
Telephone Number	:	919-284-4025
Fax Number	:	919-284-5965

Provider Business Practice Location Address
First Line	:	101 E 2ND STREET
Second Line	:
City	:	KENLY
State	:	NC
Zip	:	27542
Country	:	US
Telephone Number	:	919-284-4025
Fax Number	:	919-284-5965

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

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	05/30/2013

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