MEDICARE: DR. CRISTIN M TRECROCE DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	OS010068L	PA
2	207Q00000X	Family Medicine Physician	200800369	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	232359401	OTHER	PA	GREAT VALLEY HEALTH
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427020437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRISTIN M TRECROCE DO

Provider Business Mailing Address
First Line	:	PO BOX 249
Second Line	:
City	:	YADKINVILLE
State	:	NC
Zip	:	27055-0249
Country	:	US
Telephone Number	:	336-679-4963
Fax Number	:	336-679-2549

Provider Business Practice Location Address
First Line	:	380 PARKWOOD MEDICAL PARK
Second Line	:
City	:	ELKIN
State	:	NC
Zip	:	28621-2444
Country	:	US
Telephone Number	:	336-835-9355
Fax Number	:	336-835-8581

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	12/28/2010

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