Provider Demographics
NPI:1275595118
Name:DEAL, TRACEY C (MD)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:C
Last Name:DEAL
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 1:1001 HIOAKS RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4029
Mailing Address - Country:US
Mailing Address - Phone:804-320-7139
Mailing Address - Fax:804-323-0153
Practice Address - Street 1:1001 HIOAKS RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-4029
Practice Address - Country:US
Practice Address - Phone:804-320-7139
Practice Address - Fax:804-323-0153
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101053916174400000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006724744Medicaid