Provider Demographics
NPI:1326238429
Name:WOLBRINK, TRACI A (MD)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:A
Last Name:WOLBRINK
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 1:103 SAINT ROSE ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3927
Mailing Address - Country:US
Mailing Address - Phone:617-355-7327
Mailing Address - Fax:
Practice Address - Street 1:CHILDREN'S HOSPITAL/CRITICAL CARE MED
Practice Address - Street 2:300 LONGWOOD AVE, BADER 634
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-355-7327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA231622208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics