Provider Demographics
NPI:1134122286
Name:ROESING, TRACEY (MD)
Entity Type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:
Last Name:ROESING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 OLD YORK ROAD
Mailing Address - Street 2:SUITE #108
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2852
Mailing Address - Country:US
Mailing Address - Phone:215-481-2725
Mailing Address - Fax:215-481-3013
Practice Address - Street 1:500 OLD YORK RD
Practice Address - Street 2:SUITE #108
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-2852
Practice Address - Country:US
Practice Address - Phone:215-481-2725
Practice Address - Fax:215-481-3013
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD420073207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019538210003Medicaid
PA0019538210003Medicaid
PA069095Medicare PIN