Provider Demographics
NPI:1407056781
Name:TRACEY-ALLEN, WENDE (PA)
Entity Type:Individual
Prefix:
First Name:WENDE
Middle Name:
Last Name:TRACEY-ALLEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6569 N CHARLES ST
Mailing Address - Street 2:PPW # 406
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-6831
Mailing Address - Country:US
Mailing Address - Phone:443-849-2484
Mailing Address - Fax:443-849-3067
Practice Address - Street 1:15001 SHADY GROVE RD
Practice Address - Street 2:SUITE 310
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6352
Practice Address - Country:US
Practice Address - Phone:301-340-1188
Practice Address - Fax:301-340-6478
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDC0001446363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant