Healthcare Provider Details

I. General information

NPI: 1295420800
Provider Name (Legal Business Name): TACORA LEMELLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MANNING DR
CHAPEL HILL NC
27514-4220
US

IV. Provider business mailing address

PEDIATRIC EDUCATION OFFICE CAMPUS BOX 7593
CHAPEL HILL NC
27599-7593
US

V. Phone/Fax

Practice location:
  • Phone: 984-974-7337
  • Fax:
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 Number2026-02309
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: