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General NPI Number Information
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NPI Number | 1700853660
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Entity Type | Individual
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Provider Name | TRACY M BLACK M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/01/2006
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Last Update Date | 01/30/2013
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Provider Practice Location Address
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Address Line | 4220 N ROXBORO ST
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City | DURHAM
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State | NC
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Zip | 27704-1826
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Country | US
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Telephone | 919-471-1518
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Fax |
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Provider Business Mailing Address
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Address Line | 5213 S ALSTON AVE
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City | DURHAM
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State | NC
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Zip | 27713-4430
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Country | US
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Telephone | 919-620-4467
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Fax |
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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 | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 9400724
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License Number State | NC
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