Provider Demographics
NPI:1548789522
Name:TRAPP, TRACY R (MLT)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:R
Last Name:TRAPP
Suffix:
Gender:F
Credentials:MLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 MERRIMONT DR
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016-6802
Mailing Address - Country:US
Mailing Address - Phone:803-629-3199
Mailing Address - Fax:803-724-4535
Practice Address - Street 1:9005 TWO NOTCH RD STE 22
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-5850
Practice Address - Country:US
Practice Address - Phone:803-629-1937
Practice Address - Fax:803-724-4535
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-12
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC42D2135327291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory