Provider Demographics
NPI:1831263557
Name:MEYERS, TRACY ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:ELIZABETH
Last Name:MEYERS
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 1:1901 HILLANDALE RD
Mailing Address - Street 2:24B
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-2664
Mailing Address - Country:US
Mailing Address - Phone:919-383-5437
Mailing Address - Fax:
Practice Address - Street 1:1901 HILLANDALE RD
Practice Address - Street 2:24B
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-2664
Practice Address - Country:US
Practice Address - Phone:919-383-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200001206207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89132WAMedicaid
NCE17720Medicare UPIN
NC89132WAMedicaid