Organization
ROBERT J TRACE JR MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT JOHN TRACE JR. MD (PHYSICIAN/OWNER)
(301) 739-2560
Entity
Organization
Contact information
Practice address
121 E ANTIETAM ST, HAGERSTOWN, MD 21740-5601
(301) 739-2560
(301) 739-0266
Mailing address
121 E ANTIETAM ST, HAGERSTOWN, MD 21740-5601
(301) 739-2560
(301) 739-0266
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
D22012
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
964111400MD
—
MD
Enumeration date
01/29/2010
Last updated
01/29/2010
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