Provider Demographics
NPI:1225120579
Name:WRIGHT, TRACY (NP)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 629
Mailing Address - Street 2:601 ELMWOOD AVE
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-758-5700
Mailing Address - Fax:585-758-1299
Practice Address - Street 1:2365 CLINTON AVE S
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2663
Practice Address - Country:US
Practice Address - Phone:585-758-5700
Practice Address - Fax:585-758-1299
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333914-1208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics