Provider Demographics
NPI:1376768127
Name:TRACEY JONES, M.D., P.C.
Entity Type:Organization
Organization Name:TRACEY JONES, M.D., P.C.
Other - Org Name:PSYCHPHILLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-923-2690
Mailing Address - Street 1:1511 CARPENTER ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-2110
Mailing Address - Country:US
Mailing Address - Phone:215-923-2690
Mailing Address - Fax:215-923-8940
Practice Address - Street 1:1511 CARPENTER ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-2110
Practice Address - Country:US
Practice Address - Phone:215-923-2690
Practice Address - Fax:215-923-8940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD064120L2084P0800X, 2084P0804X, 2084P0800X
DEC1-00058002084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty