Provider Demographics
NPI:1639169733
Name:BYRNE, TRACY S (MD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:S
Last Name:BYRNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6301 UNIVERSITY COMMONS
Mailing Address - Street 2:STE 230
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1571
Mailing Address - Country:US
Mailing Address - Phone:574-251-2100
Mailing Address - Fax:574-251-2151
Practice Address - Street 1:6301 UNIVERSITY COMMONS
Practice Address - Street 2:SUITE 310
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1571
Practice Address - Country:US
Practice Address - Phone:574-232-1471
Practice Address - Fax:574-239-8511
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH10357207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30011688Medicaid
NHHL0041OtherHARVARD PILGRIM
NH364352OtherMVP
NH0704678OtherUNITED HEALTH CARE
NH5084658OtherAETNA
NHNH0008644OtherCHAMPUS
NH0105013Y0NH02OtherBLUE CROSS BLUE SHIELD
NH2690350OtherCIGNA
NH2690350OtherCIGNA
NH5084658OtherAETNA