Provider Demographics
NPI:1629275235
Name:PROTELL, TRACY REGINA (MD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:REGINA
Last Name:PROTELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TRACY
Other - Middle Name:REGINA
Other - Last Name:SCHEGG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1111 EMERALD BAY RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-6207
Mailing Address - Country:US
Mailing Address - Phone:530-543-5659
Mailing Address - Fax:530-541-8723
Practice Address - Street 1:155 HWY 50
Practice Address - Street 2:
Practice Address - City:STATELINE
Practice Address - State:NV
Practice Address - Zip Code:89449
Practice Address - Country:US
Practice Address - Phone:775-589-8946
Practice Address - Fax:775-588-1354
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV14443208000000X, 2084P0800X
CAA122555208000000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No208000000XAllopathic & Osteopathic PhysiciansPediatrics