Provider Demographics
NPI:1376639443
Name:MAALOUF, TRACY LYNN (PA C)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:LYNN
Last Name:MAALOUF
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:105 DEER RUN DR
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-2873
Mailing Address - Country:US
Mailing Address - Phone:724-482-4188
Mailing Address - Fax:724-283-4612
Practice Address - Street 1:407 W JEFFERSON ST STE B
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-5485
Practice Address - Country:US
Practice Address - Phone:724-283-1005
Practice Address - Fax:724-283-4612
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001492L363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS68251Medicare UPIN
PA525439QJDMedicare PIN