Provider Demographics
NPI:1144396342
Name:TRAKIMAS, CAROL ANN (DO)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANN
Last Name:TRAKIMAS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:2613 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9424
Practice Address - Country:US
Practice Address - Phone:919-736-0222
Practice Address - Fax:919-736-0223
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20010287207N00000X
NC200100287207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H77656Medicare UPIN
018421K92Medicare ID - Type Unspecified