Provider Demographics
NPI:1427020437
Name:TRECROCE, CRISTIN M (DO)
Entity Type:Individual
Prefix:DR
First Name:CRISTIN
Middle Name:M
Last Name:TRECROCE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:YADKINVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27055-0249
Mailing Address - Country:US
Mailing Address - Phone:336-679-4963
Mailing Address - Fax:336-679-2549
Practice Address - Street 1:380 PARKWOOD MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-2444
Practice Address - Country:US
Practice Address - Phone:336-835-9355
Practice Address - Fax:336-835-8581
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010068L207Q00000X
NC200800369207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018288970004Medicaid
PA232359401OtherGREAT VALLEY HEALTH
NC5910956Medicaid
NC5910956Medicaid
NC2401641Medicare PIN
H31063Medicare UPIN