Individual
DR. TRACY JANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
24A MAGOTHY BEACH RD, PASADENA, MD 21122-4428
(410) 255-2700
(410) 437-1962
Mailing address
1111 BENFIELD BLVD, SUITE 200, MILLERSVILLE, MD 21108-3002
(410) 729-5100
(410) 729-5156
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
D0062357
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
132272
JHHC PROVIDER NUMBER
MD
01
—
1438610
AETNA CAPITATED
MD
01
—
2167140
MAMSI SPECIALIST
MD
01
—
3576324
CIGNA PIN
—
05
—
407728800
—
MD
01
—
5221541
AETNA FEE FOR SERVICE
MD
01
—
646211-03
CAREFIRST MD RENDERING
MD
01
—
7605-0088
CAREFIRST BLUECHOICE
MD
01
—
8167140
MAMSI PRIMARY CARE
MD
01
—
P00388727
RR MEDICARE
MD
01
—
P17639
CAREFIRST MD POS
MD
Enumeration date
07/09/2006
Last updated
01/24/2011
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