Provider Demographics
NPI:1760443501
Name:BRAMBLE, TRACY WERTHEIMER (DPM)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:WERTHEIMER
Last Name:BRAMBLE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:TRACY
Other - Middle Name:ANN
Other - Last Name:WERTHEIMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:461 PEMBROOKE BLVD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-1909
Mailing Address - Country:US
Mailing Address - Phone:410-760-3999
Mailing Address - Fax:
Practice Address - Street 1:1412 CRAIN HWY N
Practice Address - Street 2:STE 1A
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-9306
Practice Address - Country:US
Practice Address - Phone:410-760-3999
Practice Address - Fax:410-760-3077
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01347213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD409549900Medicaid
MD409549900Medicaid
MDU88882Medicare UPIN