Provider Demographics
NPI:1780630269
Name:SAWYER-NASH, TRACY (MD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:
Last Name:SAWYER-NASH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6202 SPYGLASSRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-3773
Mailing Address - Country:US
Mailing Address - Phone:410-474-7873
Mailing Address - Fax:
Practice Address - Street 1:3802 PAXTON AVE STE 1
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45209-2399
Practice Address - Country:US
Practice Address - Phone:513-559-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH094014207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD405453900Medicaid
MDI12328Medicare UPIN
MD405453900Medicaid