Basic Information
| Provider Information | |||||||||
| NPI: | 1831263557 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEYERS | ||||||||
| FirstName: | TRACY | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1901 HILLANDALE RD | ||||||||
| Address2: | 24B | ||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277052664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9193835437 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1901 HILLANDALE RD | ||||||||
| Address2: | 24B | ||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277052664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9193835437 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2006 | ||||||||
| LastUpdateDate: | 02/18/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 200001206 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 89132WA | 05 | NC | MEDICAID |