Provider Demographics
NPI:1639465867
Name:MCLEAN-SCOCUZZA, TRACY NICOLE (MD)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:NICOLE
Last Name:MCLEAN-SCOCUZZA
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 1:2905 CROUSE LN
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-8833
Mailing Address - Country:US
Mailing Address - Phone:336-538-2494
Mailing Address - Fax:336-538-2497
Practice Address - Street 1:1409 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8776
Practice Address - Country:US
Practice Address - Phone:336-584-5659
Practice Address - Fax:336-584-4072
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-02019207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine