Gardner, Tracie Pham

Gardner, Tracie Pham is an individual health care provider with primary practice located at 800 Washington St Box #802, Boston MA 02111-1552. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology, Allopathic & Osteopathic Physicians / Neuropathology. Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology is her primary health care specialty. Gardner, Tracie Pham can be contacted via phone (617) 636-1152.

Contact Information

Primary practice address
800 Washington St Box #802 Boston MA 02111-1552
Phone: (617) 636-1152
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology 207ZP0102X R71171 Arizona
Allopathic & Osteopathic Physicians / Neuropathology 207ZN0500X A110863 California

Profile Details

NPI number 1912143835
LBN Legal business name Gardner, Tracie Pham
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 23rd, 2008
Last updated Oct 24th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1912143835 NPPES
Other R71171 TRAINING PERMIT
Other A110863 TRAINING PERMIT

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