Provider Demographics
NPI:1336308782
Name:PRICE, TRACY R (MD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:R
Last Name:PRICE
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 1:679 E COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1049
Mailing Address - Country:US
Mailing Address - Phone:317-890-2000
Mailing Address - Fax:317-859-4269
Practice Address - Street 1:679 E COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1049
Practice Address - Country:US
Practice Address - Phone:317-893-1980
Practice Address - Fax:317-893-1981
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11013494A2085R0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200995880Medicaid
INP00897024OtherRAILROAD MEDICARE PIN
INP01456896OtherRAIL ROAD PTAN
IN200995880Medicaid
INP01456896OtherRAIL ROAD PTAN
INP00897024OtherRAILROAD MEDICARE PIN
INM400056806Medicare PIN
IN266180504Medicare PIN