Provider Demographics
NPI:1104827161
Name:PRIZANT, TRACY LYNN (MD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:PRIZANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5770 BAUM BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-3763
Mailing Address - Country:US
Mailing Address - Phone:412-661-5500
Mailing Address - Fax:412-661-4365
Practice Address - Street 1:5770 BAUM BLVD
Practice Address - Street 2:STE 200
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3763
Practice Address - Country:US
Practice Address - Phone:412-661-5500
Practice Address - Fax:412-661-4365
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2010-10-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD057723L207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA834323OtherHIGHMARK BLUE CROSS/BLUE
PA0015942410001Medicaid
G34690Medicare UPIN
PA0015942410001Medicaid