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General NPI Number Information
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NPI Number | 1548789522
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Entity Type | Individual
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Provider Name | TRACY R TRAPP MLT
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Gender | Female
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Dates
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Enumeration Date | 09/12/2017
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Last Update Date | 09/12/2017
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Provider Practice Location Address
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Address Line | 9005 TWO NOTCH RD STE 22
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City | COLUMBIA
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State | SC
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Zip | 29223-5850
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Country | US
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Telephone | 803-629-1937
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Fax | 803-724-4535
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Provider Business Mailing Address
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Address Line | 208 MERRIMONT DR
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City | BLYTHEWOOD
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State | SC
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Zip | 29016-6802
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Country | US
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Telephone | 803-629-3199
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Fax | 803-724-4535
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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 | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 42D2135327
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License Number State | SC
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