Provider Demographics
NPI:1679732473
Name:VIOLA, TRACEY A (DO)
Entity Type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:A
Last Name:VIOLA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:203 OLD MILITARY ROAD, PO BOX 790
Mailing Address - Street 2:LAKE PLACID SPORTS MEDICINE
Mailing Address - City:LAKE PLACID
Mailing Address - State:NY
Mailing Address - Zip Code:12946
Mailing Address - Country:US
Mailing Address - Phone:518-523-1327
Mailing Address - Fax:518-523-9964
Practice Address - Street 1:203 OLD MILITARY RD
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:NY
Practice Address - Zip Code:12946-1738
Practice Address - Country:US
Practice Address - Phone:518-523-1327
Practice Address - Fax:518-523-9964
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY254422207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine