Provider Demographics
NPI:1841384146
Name:WARE, TRACY ANNE (MD)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:ANNE
Last Name:WARE
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 1:610 JONES FERRY RD STE 208
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-6113
Mailing Address - Country:US
Mailing Address - Phone:919-636-5695
Mailing Address - Fax:919-442-1195
Practice Address - Street 1:610 JONES FERRY RD STE 208
Practice Address - Street 2:
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-6113
Practice Address - Country:US
Practice Address - Phone:919-636-5695
Practice Address - Fax:919-442-1195
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2002014192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
E84443Medicare UPIN
2037282Medicare ID - Type Unspecified