Provider Demographics
NPI:1992794291
Name:RUNG, REBECCA DUNG (MD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:DUNG
Last Name:RUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4315 PHYSICIANS BLVD
Practice Address - Street 2:STE 101
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-7430
Practice Address - Country:US
Practice Address - Phone:704-455-6521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-00170207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AA41908OtherHARVARD PILGRIM
NC5909719Medicaid
061385OtherAETNA
NC1992794291Medicaid
ME1423Medicare PIN
061385OtherAETNA
NC5909719Medicaid