Provider Demographics
NPI:1093065757
Name:POINTON, TRACY L (RPA-C)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:L
Last Name:POINTON
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2081 W RIDGE RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-2724
Mailing Address - Country:US
Mailing Address - Phone:585-227-4560
Mailing Address - Fax:585-227-4608
Practice Address - Street 1:2081 W RIDGE RD
Practice Address - Street 2:SUITE 205
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-2724
Practice Address - Country:US
Practice Address - Phone:585-227-4560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY15792363AM0700X
NY015792363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY015792OtherLICENSE
MDC0004935OtherTHE BOARD OF PHYSICIANS OF THE STATE OF MARYLAND