Provider Demographics
NPI:1174511448
Name:TRACY, MARTHA A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:A
Last Name:TRACY
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 1:3100 TELEGRAPH AVE
Mailing Address - Street 2:SUITE 3101
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3239
Mailing Address - Country:US
Mailing Address - Phone:510-834-6923
Mailing Address - Fax:510-848-0801
Practice Address - Street 1:3100 TELEGRAPH AVE
Practice Address - Street 2:SUITE 3101
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3239
Practice Address - Country:US
Practice Address - Phone:510-834-6923
Practice Address - Fax:510-848-0801
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG312462174400000X
CAG31246207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA44701Medicare UPIN
CAG312462Medicare ID - Type Unspecified