Healthcare Provider Details

I. General information

NPI: 1437176138
Provider Name (Legal Business Name): KENYA A. MCNEAL-TRICE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 06/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNC SCHOOL OF MEDICINE CAMPUS BOX 7593
CHAPEL HILL NC
27599-7593
US

IV. Provider business mailing address

UNC SCHOOL OF MEDICINE CAMPUS BOX 7593
CHAPEL HILL NC
27599-7593
US

V. Phone/Fax

Practice location:
  • Phone: 919-966-3172
  • Fax: 919-966-8419
Mailing address:
  • Phone: 919-966-3172
  • Fax: 919-966-8419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2005-00929
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier5901945
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: