Individual
JEREMIAH CHARLES TRACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655-0002
(508) 856-4161
(508) 856-6703
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
(800) 225-8885
(508) 334-1977
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
257266
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110103635A
—
MA
Enumeration date
07/04/2009
Last updated
11/04/2016
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