Provider Demographics
NPI:1669676102
Name:BURDE, TRACEY HORNER I (LIC AC)
Entity Type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:HORNER
Last Name:BURDE
Suffix:I
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5810 WYNGATE DR
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-2556
Mailing Address - Country:US
Mailing Address - Phone:301-537-8868
Mailing Address - Fax:301-530-3368
Practice Address - Street 1:5810 WYNGATE DR
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-2556
Practice Address - Country:US
Practice Address - Phone:301-537-8868
Practice Address - Fax:301-530-3368
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDUO471171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist