Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0105X | Surgery of the Hand | 14893 | WV |
N | 2086S0105X | Surgery of the Hand | 35054828 | OH |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 14893 | WV |
N | 2086S0122X | Plastic and Reconstructive Surgery | 35054828 | OH |
NPI | 1518953116 |
---|---|
Provider Name | Dr. Charles Alan Tracy |
First Address | Wheeling, WV 26003-6392 |
Second Address | Wheeling, WV 26003-6392 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2005 |
Last Update Date | 14/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0114127000 | (05) | WV |
0859085 | (05) | OH |
14893 | HMO (01) | |
F44283 | (02) |