Individual
ANTHONY JOSEPH TRACEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
725 IRVING AVE, SUITE 403, SYRACUSE, NY 13210-2306
(315) 464-6060
(315) 464-2879
Mailing address
251 SALINA MEADOWS PKWY STE 100, SYRACUSE, NY 13212-4516
(315) 464-2000
(315) 464-2010
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
295550
NY
2088P0231X
Pediatric Urology Physician
073861
GA
2088P0231X
Pediatric Urology Physician
Primary
295550
NY
2088P0231X
Pediatric Urology Physician
40393
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05295565
—
NY
Enumeration date
04/21/2010
Last updated
10/22/2019
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