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General NPI Number Information
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NPI Number | 1972879799
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Entity Type | Individual
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Provider Name | TRACI A DEVOE M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/27/2012
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Last Update Date | 10/04/2017
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Provider Practice Location Address
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Address Line | 2781 TRICOM ST PALMETTO PEDIATRICS, PA
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City | N CHARLESTON
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State | SC
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Zip | 29406-9170
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Country | US
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Telephone | 843-797-5600
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Fax | 843-572-4872
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Provider Business Mailing Address
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Address Line | 2781 TRICOM ST
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City | N CHARLESTON
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State | SC
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Zip | 29406-9170
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Country | US
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Telephone | 843-797-5600
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Fax | 843-572-4872
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 35122644
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 40795
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License Number State | SC
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