Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 175287-1 | NY |
N | 208G00000X | Cardiothoracic Vascular Surgeon | 36727 | WI |
N | 208G00000X | Cardiothoracic Vascular Surgeon | MD19413 | ME |
NPI | 1003870619 |
---|---|
Provider Name | Tracey L Weigel |
First Address | Hawthorne, NY 10532-2140 |
Second Address | Valhalla, NY 10595-1530 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2006 |
Last Update Date | 25/05/2021 |