Individual
REBECCA L. LARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4539 HEDGEMORE DR, SUITE 100, CHARLOTTE, NC 28209-3276
(704) 331-9669
(704) 331-0736
Mailing address
PO BOX 601888, CHARLOTTE, NC 28260-1888
(704) 331-9669
(704) 331-0736
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
2000-00506
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1295711554
—
NC
05
—
89126YR
—
NC
05
—
N00507
—
SC
Enumeration date
12/19/2005
Last updated
08/18/2014
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