Individual
DAVID A. TRACEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
593 EDDY ST, APC MAIN, PROVIDENCE, RI 02903-4923
(401) 444-5435
(401) 444-5256
Mailing address
593 EDDY ST, APC MAIN, PROVIDENCE, RI 02903-4923
(401) 444-5435
(401) 444-5256
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00333
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27438-8
BLUE CROSS
RI
Enumeration date
07/03/2006
Last updated
06/10/2010
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