Provider Demographics
NPI:1073723227
Name:KENDRICK, TRACY WOGAN (MD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:WOGAN
Last Name:KENDRICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 PERIMETER PARK DR
Mailing Address - Street 2:SUITE 225
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-8421
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6602 KNIGHTDALE BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-6525
Practice Address - Country:US
Practice Address - Phone:919-747-5270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201376207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2009-00224OtherMEDICAL LICENSE
NC5912522Medicaid
NC2009-00224OtherMEDICAL LICENSE