Individual
CHARLES A TRACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
230 WORCESTER ST, WELLESLEY, MA 02481-5420
(781) 431-5415
(781) 431-5465
Mailing address
147 MILK ST, PROVIDER ENROLLMENT - 9TH FLOOR, BOSTON, MA 02109-4806
(617) 559-8374
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
45225
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0014888
NEIGHBORHOOD HEALTH
MA
01
—
045225
TUFTS
MA
05
—
3053440
—
MA
01
—
B11722
BLUE CROSS
MA
01
—
M114
HARVARD PILGRIM
MA
Enumeration date
05/19/2006
Last updated
06/27/2011
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