Provider Demographics
NPI:1760420715
Name:PRATT, TANYA SUZANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:TANYA
Middle Name:SUZANNE
Last Name:PRATT
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 1:930 3RD ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-6967
Mailing Address - Country:US
Mailing Address - Phone:336-890-3200
Mailing Address - Fax:336-890-3290
Practice Address - Street 1:930 3RD ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-6967
Practice Address - Country:US
Practice Address - Phone:336-890-3200
Practice Address - Fax:336-890-3290
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200300868207Q00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7490OtherPARTNERS MEDICARE CHOICE
NC7519483OtherAETNA
NCC7390OtherMEDCOST
NC134R8OtherBCBS NC
NC89134R8Medicaid
NCD0470OtherMEDCOST
NC3301OtherPARTNERS MEDICARE CHOICE
NC134R8OtherBCBS NC
NC2020903BMedicare ID - Type UnspecifiedMEDICARE
NC134R8OtherBCBS NC