Provider Demographics
NPI:1013021716
Name:MCNEISH, TRACY STROMA (MD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:STROMA
Last Name:MCNEISH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:STROMA
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9900 INDEPENDENCE PARK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1473
Mailing Address - Country:US
Mailing Address - Phone:804-747-1855
Mailing Address - Fax:804-762-8837
Practice Address - Street 1:9900 INDEPENDENCE PARK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-1473
Practice Address - Country:US
Practice Address - Phone:804-747-1855
Practice Address - Fax:804-762-8837
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-238800208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
181796OtherANTHEM - HENRICO COUNTY
329785OtherSOUTHERN HEALTH
181868OtherANTHEM - HANOVER COUNTY
VA6730442Medicaid