Provider Demographics
NPI:1588698229
Name:VADEN, TRACELA (MD)
Entity type:Individual
Prefix:
First Name:TRACELA
Middle Name:
Last Name:VADEN
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:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 S COLLEGE ST
Practice Address - Street 2:STE 500
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-2012
Practice Address - Country:US
Practice Address - Phone:704-302-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22945207R00000X
NC200300207207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC133PEOtherBCBS
SC229452Medicaid
NC1588698229Medicaid
NC89133PEMedicaid
NCNC4975DMedicare PIN
NCNC4975GMedicare PIN
NC2017648Medicare PIN
NC1588698229Medicaid
NCNC4975FMedicare PIN
NC2017648AMedicare PIN
NCG87017Medicare UPIN
NC89133PEMedicaid
NCNC4975BMedicare UPIN
NCNC4975EMedicare PIN
NCNC4975AMedicare PIN