Provider Demographics
NPI:1649220153
Name:MASSA, TRACY (MD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:
Last Name:MASSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:HURTEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6700 KIRKVILLE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-9305
Mailing Address - Country:US
Mailing Address - Phone:315-463-2013
Mailing Address - Fax:315-463-2019
Practice Address - Street 1:6700 KIRKVILLE RD
Practice Address - Street 2:SUITE A
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9305
Practice Address - Country:US
Practice Address - Phone:315-463-2013
Practice Address - Fax:315-463-2019
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227536208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02412224Medicaid
NY02412224Medicaid
NYDD5970Medicare ID - Type Unspecified