Provider Demographics
NPI:1467486456
Name:BLUSEWICZ, TRACY ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:ANN
Last Name:BLUSEWICZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 PLANTATION PARK DR STE 401
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-9006
Mailing Address - Country:US
Mailing Address - Phone:843-341-9700
Mailing Address - Fax:843-341-3282
Practice Address - Street 1:29 PLANTATION PARK DR STE 401
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-9006
Practice Address - Country:US
Practice Address - Phone:843-341-9700
Practice Address - Fax:843-341-3282
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26583207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC265830Medicaid
SC265830Medicaid
SCH28551Medicare UPIN