Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | MD15554 | HI |
NPI | 1013152594 |
---|---|
Provider Name | Dr. Christopher Lee Tracy |
First Address | Bethesda, MD 20889-5600 |
Second Address | Bethesda, MD 20889-5600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2008 |
Last Update Date | 14/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
VAD000 | (02) | HI |