Provider Demographics
NPI:1336131366
Name:TRAXLER, MARYANN (MD)
Entity Type:Individual
Prefix:
First Name:MARYANN
Middle Name:
Last Name:TRAXLER
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 1:521 CLANTON RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217
Mailing Address - Country:US
Mailing Address - Phone:704-332-9001
Mailing Address - Fax:704-295-1755
Practice Address - Street 1:100 BILLINGSLEY RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1002
Practice Address - Country:US
Practice Address - Phone:704-376-7447
Practice Address - Fax:704-376-2172
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC97007842084A0401X, 2084P0800X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1094YOtherBCBS
02973OtherBCBS GROUP
NC2136229OtherAETNA
NCD91786Medicare UPIN
NC2136229OtherAETNA