Provider Demographics
NPI:1558354274
Name:DIMARCO, TRACIE L (MD)
Entity Type:Individual
Prefix:DR
First Name:TRACIE
Middle Name:L
Last Name:DIMARCO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4068 ALBANY POST RD
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538-3900
Mailing Address - Country:US
Mailing Address - Phone:845-229-2123
Mailing Address - Fax:845-229-6313
Practice Address - Street 1:4068 ALBANY POST RD
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:12538-3900
Practice Address - Country:US
Practice Address - Phone:845-229-2123
Practice Address - Fax:845-229-6313
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY220557207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02164941Medicaid
NYH42718Medicare UPIN