Provider Demographics
NPI:1023104981
Name:FARMER, TRACIE CHRISTINE (MD)
Entity type:Individual
Prefix:
First Name:TRACIE
Middle Name:CHRISTINE
Last Name:FARMER
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 1:2000 FRONTIS PLAZA BLVD STE 102
Mailing Address - Street 2:NOVANT MEDICAL GROUP
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5616
Mailing Address - Country:US
Mailing Address - Phone:336-277-2436
Mailing Address - Fax:
Practice Address - Street 1:755 HIGHLAND OAKS DR STE 201
Practice Address - Street 2:DBA FORSYTH ENDOCRINE CONSULTANTS
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-7106
Practice Address - Country:US
Practice Address - Phone:336-765-0020
Practice Address - Fax:336-765-0581
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN9084207RE0101X
NC2007-00588207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5907257Medicaid
NC5907257Medicaid
NC2069458Medicare PIN