Provider Demographics
NPI:1417396508
Name:HARRIS, TRACEY ALISON (DO)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:ALISON
Last Name:HARRIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 MEDICAL CENTER BLVD
Mailing Address - Street 2:POB 1, SUITE 402 - PEDS RESIDENCY
Mailing Address - City:CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19013-3955
Mailing Address - Country:US
Mailing Address - Phone:610-447-6680
Mailing Address - Fax:610-447-6677
Practice Address - Street 1:30 MEDICAL CENTER BLVD
Practice Address - Street 2:POB 1, SUITE 402 - PEDS RESIDENCY
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-3955
Practice Address - Country:US
Practice Address - Phone:610-447-6680
Practice Address - Fax:610-447-6677
Is Sole Proprietor?:No
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT015540208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics