Provider Demographics
NPI:1265473284
Name:MOORE, TRACY
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 LOCUST ST
Mailing Address - Street 2:SUITE 403
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15219-5136
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1400 LOCUST ST
Practice Address - Street 2:MERCY HOSPITAL OF PITTSBURGH
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15219-5114
Practice Address - Country:US
Practice Address - Phone:412-232-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD426951207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7746810OtherAETNA PIN
PA1757637OtherBCBS PA
PAP00324179OtherRR MEDICARE
PA1551156OtherGATEWAY
PA4871888OtherCIGNA
PA5677777JK6OtherPA MCR GROUP PTAN
PA1313685OtherAETNA PVN
PA1313685OtherAETNA PVN
PA1551156OtherGATEWAY