Provider Demographics
NPI:1376679001
Name:TRIDICO, TRINA INSOOK (MD)
Entity Type:Individual
Prefix:
First Name:TRINA
Middle Name:INSOOK
Last Name:TRIDICO
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:PO BOX 890273
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-0273
Mailing Address - Country:US
Mailing Address - Phone:828-328-2231
Mailing Address - Fax:828-323-1562
Practice Address - Street 1:24 2ND AVE NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-5045
Practice Address - Country:US
Practice Address - Phone:828-328-2231
Practice Address - Fax:828-323-1562
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-00098207Q00000X, 209800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No209800000XAllopathic & Osteopathic PhysiciansLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5911061Medicaid
NCCN8132OtherMEDICARE RAILROAD
NCCN8132OtherMEDICARE RAILROAD
NC2023374AMedicare PIN