Individual
TRACY L NEUENDORF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1011 BOARDMAN CANFIELD RD, YOUNGSTOWN, OH 44512-4226
(330) 629-2888
(330) 629-8940
Mailing address
1011 BOARDMAN CANFIELD RD, YOUNGSTOWN, OH 44512-4226
(330) 629-2888
(330) 629-8940
Taxonomy
Speciality
Code
Description
License number
State
207LA0401X
Addiction Medicine (Anesthesiology) Physician
34.003509
OH
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
34-00-3509-N
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000403561
HIGHMARK BC/BS
OH
05
—
0010273680005
—
PA
05
—
0601834
—
OH
01
—
127674
ANTHEM
OH
Enumeration date
02/28/2006
Last updated
04/30/2020
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