Individual
DR. TRACIE PHAM GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
800 WASHINGTON ST, BOX #802, BOSTON, MA 02111-1552
(617) 636-1152
Mailing address
800 WASHINGTON ST, BOX #802, BOSTON, MA 02111-1552
(617) 636-1152
Taxonomy
Speciality
Code
Description
License number
State
207ZN0500X
Neuropathology Physician
A110863
CA
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
R71171
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A110863
CALIFORNIA MEDICAL LICENSE
CA
01
—
R71171
TRAINING PERMIT
—
Enumeration date
12/23/2008
Last updated
10/24/2012
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