Provider Demographics
NPI:1831472166
Name:TRACY, MEGAN C D (NP)
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:C D
Last Name:TRACY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:WINCHENDON
Mailing Address - State:MA
Mailing Address - Zip Code:01475-1820
Mailing Address - Country:US
Mailing Address - Phone:978-297-2311
Mailing Address - Fax:978-297-1791
Practice Address - Street 1:55 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:WINCHENDON
Practice Address - State:MA
Practice Address - Zip Code:01475-1820
Practice Address - Country:US
Practice Address - Phone:978-297-2311
Practice Address - Fax:978-297-1791
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN 2263045363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner