Provider Demographics
NPI:1376519199
Name:GEMZIK, TRACEY L (PA-C)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:L
Last Name:GEMZIK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1569 MEDICAL DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-3223
Mailing Address - Country:US
Mailing Address - Phone:610-327-4200
Mailing Address - Fax:610-327-8160
Practice Address - Street 1:555 GLASGOW ST
Practice Address - Street 2:
Practice Address - City:STOWE
Practice Address - State:PA
Practice Address - Zip Code:19464-6557
Practice Address - Country:US
Practice Address - Phone:484-945-0770
Practice Address - Fax:484-945-0648
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOA002061363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P60530Medicare UPIN