Provider Demographics
NPI:1689667669
Name:WATKINS, TRACI N (MD)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:N
Last Name:WATKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3909 WOODLEY RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1169
Mailing Address - Country:US
Mailing Address - Phone:419-291-2670
Mailing Address - Fax:419-479-6017
Practice Address - Street 1:3909 WOODLEY RD
Practice Address - Street 2:SUITE 500
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1169
Practice Address - Country:US
Practice Address - Phone:419-291-2670
Practice Address - Fax:419-479-6017
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35074048207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
03491OtherPARAMOUNT
OH080161014OtherRRMC
OH000000141223OtherANTHEM
OH01-04929OtherUHC
OH2153931Medicaid
OH2313822OtherAETNA
OH203089OtherBLACK LUNG
$$$$$$$$$-002OtherMMO
OH080161014OtherRRMC
OH203089OtherBLACK LUNG
OH2313822OtherAETNA
OH0891671Medicare PIN