Tracie Marie Mallberg- Sylvester, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

9395 Issued in ND

Practice address

1701 38TH St S Ste 101
Fargo, ND 58103-4499

Phone

(701) 356-1500

Fax

(701) 356-1596

NPI assigned

Aug 7, 2006

Last updated

Oct 28, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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  • NPI 1417109059
  NPD (past)
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  • NPI 1689685323
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635379200000",
    "number": "1871502740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 38TH ST S STE 101",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581034499",
            "telephone_number": "701-356-1500",
            "fax_number": "701-356-1596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 38TH ST S STE 101",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581034499",
            "telephone_number": "701-356-1500",
            "fax_number": "701-356-1596"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "550 13th Ave E",
            "address_purpose": "LOCATION",
            "city": "West Fargo",
            "state": "ND",
            "postal_code": "580783360",
            "country_code": "US",
            "telephone_number": "701-356-5459",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MALLBERG- SYLVESTER",
        "first_name": "TRACIE",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-07",
        "last_updated": "2021-10-28",
        "certification_date": "2021-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "46245",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ND",
            "license": "9395",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "156629600",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "490K2MA",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Fargo",
            "affiliation": "N",
            "endpointDescription": "office",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Fargo",
            "address_1": "1701 38 St S Ste 101",
            "city": "Fargo",
            "state": "ND",
            "country_code": "US",
            "postal_code": "58103",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Michael Oluwasegun Makinde
• Kimberly Makonnen, LAC
• Robyn Maley, PSYD
• Joshua Keith Maliske, CRNA
• Kayla Nichole Maliske
• Nora Mallow
• Hani Malone, M.D.
• Inna Malostovker, MD
• Tracie Malsom, OD
• Katarina Malterud

• Family Medicine Physician in Fargo, ND
• Providers in Fargo, ND by specialty
• Family Medicine Physician in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.