Provider Demographics
NPI:1457446874
Name:BYLAN, TRACY (PA)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:BYLAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 COTTAGE GROVE RD STE E010
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-4224
Mailing Address - Country:US
Mailing Address - Phone:860-241-4835
Mailing Address - Fax:860-244-3516
Practice Address - Street 1:701 COTTAGE GROVE RD STE E010
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-4224
Practice Address - Country:US
Practice Address - Phone:860-241-4835
Practice Address - Fax:860-244-3516
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT01738363AM0700X, 363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT970002036Medicare ID - Type Unspecified
Q61377Medicare UPIN