Provider Demographics
NPI:1477531242
Name:TRATE, DOUGLAS MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:MICHAEL
Last Name:TRATE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 STATE FARM RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-4861
Mailing Address - Country:US
Mailing Address - Phone:828-264-0029
Mailing Address - Fax:828-265-3305
Practice Address - Street 1:870 STATE FARM RD
Practice Address - Street 2:SUITE 102
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4861
Practice Address - Country:US
Practice Address - Phone:828-264-0029
Practice Address - Fax:828-265-3305
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC96000754207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8901472Medicaid
NCG29320Medicare UPIN
NC8901472Medicaid