Individual
ANDREA TRACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
74 BARIBEAU DR, BRUNSWICK, ME 04011-3218
(207) 798-4050
(207) 798-4018
Mailing address
PO BOX 9746, PORTLAND, ME 04104-5040
(207) 791-3888
(207) 828-7850
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD12917
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
285990099
—
ME
Enumeration date
08/08/2006
Last updated
08/09/2012
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