Individual
TRACY L KEDIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
279 LINCOLN ST, WORCESTER, MA 01605-2120
(508) 334-8830
(508) 334-8810
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
(888) 225-8885
(508) 334-1977
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
159787
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1300709 (GROUP)
—
MA
01
—
Y10141
MEDICARE GROUP #
MA
Enumeration date
01/23/2007
Last updated
09/26/2022
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