Individual
TRACY LEE MATHENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
600 W RIDGE RD, WYTHE COUNTY COMMUNITY HOSPITAL, WYTHEVILLE, VA 24382-1044
(276) 228-1775
(276) 228-1776
Mailing address
685 LORETTO DR, WYTHEVILLE, VA 24382-2085
(272) 228-2216
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101240789
VA
207R00000X
Internal Medicine Physician
0101240789
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100049800
—
KY
Enumeration date
12/16/2006
Last updated
11/03/2009
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