Provider Demographics
NPI:1750479077
Name:GOLDEN, TRACEY A (MD)
Entity Type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:A
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8203 NIGELS DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4177
Mailing Address - Country:US
Mailing Address - Phone:843-449-5848
Mailing Address - Fax:843-692-0841
Practice Address - Street 1:8203 NIGELS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4177
Practice Address - Country:US
Practice Address - Phone:843-449-5848
Practice Address - Fax:843-692-0841
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC24029207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT81970Medicaid
H906286571Medicare UPIN
H906286571Medicare ID - Type Unspecified