Healthcare Provider Details

I. General information

NPI: 1871762666
Provider Name (Legal Business Name): TRACEY CHAPIN KRUMEL AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRACEY LEIGH CHAPIN M.S.

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 01/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2711 RANDOLPH RD STE 307
CHARLOTTE NC
28207-2027
US

IV. Provider business mailing address

PO BOX 406153
ATLANTA GA
30384-1876
US

V. Phone/Fax

Practice location:
  • Phone: 704-334-4428
  • Fax: 704-332-3261
Mailing address:
  • Phone: 561-478-8770
  • Fax: 561-688-8877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number4006
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: