Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | 9801788 | NC |
NPI | 1306829015 |
---|---|
Provider Name | Dr. Debra A Tristram |
First Address | Charlotte, NC 28275-1069 |
Second Address | Greenville, NC 27834-3736 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2005 |
Last Update Date | 15/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11649 | BCBS NC (01) | NC |
370015918 | RAILROAD MEDICARE (01) | NC |
8911649 | (05) | NC |
G24975 | (02) | NC |