Provider Demographics
NPI:1972879799
Name:DEVOE, TRACI A (MD)
Entity Type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:A
Last Name:DEVOE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:ALISON
Other - Last Name:DEVOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2781 TRICOM ST
Mailing Address - Street 2:
Mailing Address - City:N CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9170
Mailing Address - Country:US
Mailing Address - Phone:843-797-5600
Mailing Address - Fax:843-572-4872
Practice Address - Street 1:2781 TRICOM ST
Practice Address - Street 2:PALMETTO PEDIATRICS, PA
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9170
Practice Address - Country:US
Practice Address - Phone:843-797-5600
Practice Address - Fax:843-572-4872
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35122644208000000X
SC40795208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0120646Medicaid
SC407955Medicaid