Healthcare Provider Details

I. General information

NPI: 1639465867
Provider Name (Legal Business Name): TRACY NICOLE MCLEAN-SCOCUZZA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2011
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 UNIVERSITY DR
BURLINGTON NC
27215-8776
US

IV. Provider business mailing address

2905 CROUSE LN
BURLINGTON NC
27215-8833
US

V. Phone/Fax

Practice location:
  • Phone: 336-584-5659
  • Fax: 336-584-4072
Mailing address:
  • Phone: 336-538-2494
  • Fax: 336-538-2497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2013-02019
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: