Provider Demographics
NPI:1255674818
Name:TRACY, JOSEPHINE (MD, MPH)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:
Last Name:TRACY
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:JOSEPHINE
Other - Middle Name:
Other - Last Name:VINCENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:9500 CLARKS CROSSING RD
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-1926
Mailing Address - Country:US
Mailing Address - Phone:860-884-5508
Mailing Address - Fax:
Practice Address - Street 1:8008 WESTPARK DR
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-3109
Practice Address - Country:US
Practice Address - Phone:860-884-5508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-02
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125065504207L00000X
390200000X
VA0101267049207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program