Provider Demographics
NPI:1033875414
Name:MCFADDEN, TRACY ELIZABETH
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:ELIZABETH
Last Name:MCFADDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1914 CLIFDEN RD
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4838
Mailing Address - Country:US
Mailing Address - Phone:443-928-9849
Mailing Address - Fax:
Practice Address - Street 1:1101 E 33RD ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-3637
Practice Address - Country:US
Practice Address - Phone:443-287-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR211514363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily