Provider Demographics
NPI:1144396052
Name:O'NEILL, TRACIE (MD)
Entity Type:Individual
Prefix:
First Name:TRACIE
Middle Name:
Last Name:O'NEILL
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 1:1011 NE HIGH STREET
Mailing Address - Street 2:SUITE #200
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1011 NE HIGH STREET
Practice Address - Street 2:SUITE #200
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029
Practice Address - Country:US
Practice Address - Phone:425-391-7337
Practice Address - Fax:425-391-3915
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00031431208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics