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General NPI Number Information
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NPI Number | 1306829015
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Entity Type | Individual
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Provider Name | DEBRA A TRISTRAM MD
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Gender | Female
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Dates
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Enumeration Date | 11/28/2005
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Last Update Date | 03/15/2012
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Provider Practice Location Address
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Address Line | 2150 HERBERT CT ECU PHYSICIANS PEDIATRIC SPECIALTY CARE CLINIC
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City | GREENVILLE
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State | NC
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Zip | 27834-3736
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Country | US
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Telephone | 252-744-5437
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Fax | 252-744-1514
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Provider Business Mailing Address
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Address Line | PO BOX 751069
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City | CHARLOTTE
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State | NC
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Zip | 28275-1069
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Country | US
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Telephone | 252-744-3253
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Fax | 252-744-3194
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0208X
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Taxonomy Name | Pediatric Infectious Diseases Physician
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License Number | 9801788
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License Number State | NC
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