Provider Demographics
NPI:1174878169
Name:SCARBOROUGH, REBECCA ANN (RD, LDN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:SCARBOROUGH
Suffix:
Gender:F
Credentials:RD, LDN
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 751069
Mailing Address - Street 2:ECU PHYSICIANS INTERNAL MEDICINE
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:252-744-3258
Mailing Address - Fax:
Practice Address - Street 1:517 MOYE BLVD FL 1
Practice Address - Street 2:ECU PHYSICIANS SURGERY
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2849
Practice Address - Country:US
Practice Address - Phone:252-744-2393
Practice Address - Fax:252-744-0018
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002194133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC172XROtherBCBSNC
NC172XROtherBCBSNC
NCNC83250322Medicare PIN