Provider Demographics
NPI:1003830647
Name:SKALE, TRACEY GOODMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:GOODMAN
Last Name:SKALE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TRACEY
Other - Middle Name:
Other - Last Name:GOODMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4965 TAFT PL
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45243-3961
Mailing Address - Country:US
Mailing Address - Phone:513-658-0012
Mailing Address - Fax:
Practice Address - Street 1:2621 VICTORY PKWY
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-1754
Practice Address - Country:US
Practice Address - Phone:513-861-6688
Practice Address - Fax:513-559-3848
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-26742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000316132OtherANRHEM PROVIDER
OH0997088Medicaid
OH0997088Medicaid
G21889Medicare UPIN
SK0797044Medicare ID - Type Unspecified