Provider Demographics
NPI:1437230901
Name:BROBYN, TRACY L (MD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:L
Last Name:BROBYN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 MULLICA HILL RD
Mailing Address - Street 2:
Mailing Address - City:GLASSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08028-1700
Mailing Address - Country:US
Mailing Address - Phone:856-256-4333
Mailing Address - Fax:856-256-4427
Practice Address - Street 1:201 MULLICA HILL RD
Practice Address - Street 2:
Practice Address - City:GLASSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08028-1700
Practice Address - Country:US
Practice Address - Phone:856-256-4333
Practice Address - Fax:856-256-4427
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06296300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080194340OtherRR MEDICARE
NJ8308900Medicaid
NJ8308900Medicaid
080194340OtherRR MEDICARE