Tracy, Jeremiah Charles
Tracy, Jeremiah Charles is an individual health care provider with primary practice located at 55 Lake Ave N , Worcester MA 01655-0002. He recently has only one registered license in Allopathic & Osteopathic Physicians / Otolaryngology, which is considered as his primary health care specialty. Tracy, Jeremiah Charles can be contacted via phone (508) 856-4161.Contact Information
Primary practice address
55 Lake Ave N
Worcester MA 01655-0002
Phone: (508) 856-4161
Fax: (508) 856-6703
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Otolaryngology | 207Y00000X | 257266 | Massachusetts |
Profile Details
| NPI number | 1215166889 |
|---|---|
| LBN Legal business name | Tracy, Jeremiah Charles |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 4th, 2009 |
| Last updated | Nov 4th, 2016 - about 8 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1215166889 | NPPES |
| Massachusetts | MEDICAID | 110103635A |
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