Provider Demographics
NPI:1063487338
Name:SEEWALD, TRACY
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:SEEWALD
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 1:3436 WILLIAM PENN HWY
Mailing Address - Street 2:BUILDING 2
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15235-5411
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3436 WILLIAM PENN HWY
Practice Address - Street 2:BUILDING 2
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15235-5411
Practice Address - Country:US
Practice Address - Phone:412-823-6222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039534E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE13041Medicare UPIN
PA554204PD9Medicare ID - Type Unspecified