Healthcare Provider Details

I. General information

NPI: 1023104981
Provider Name (Legal Business Name): TRACIE CHRISTINE FARMER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 10/28/2020
Certification Date: 09/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 HIGHLAND OAKS DR STE 201 DBA FORSYTH ENDOCRINE CONSULTANTS
WINSTON SALEM NC
27103-7106
US

IV. Provider business mailing address

2000 FRONTIS PLAZA BLVD STE 102 NOVANT MEDICAL GROUP
WINSTON SALEM NC
27103-5616
US

V. Phone/Fax

Practice location:
  • Phone: 336-765-0020
  • Fax: 336-765-0581
Mailing address:
  • Phone: 336-277-2436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberTRN9084
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number2007-00588
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: