Provider Demographics
NPI:1881657567
Name:AGEE, TRACY ANNE (ADULT NP)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:ANNE
Last Name:AGEE
Suffix:
Gender:F
Credentials:ADULT NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 E MONUMENT ST
Mailing Address - Street 2:8TH FLOOR: GENERAL INTERNAL MEDICINE
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287-0020
Mailing Address - Country:US
Mailing Address - Phone:443-287-2030
Mailing Address - Fax:
Practice Address - Street 1:1830 E MONUMENT ST
Practice Address - Street 2:8TH FLOOR: GENERAL INTERNAL MEDICINE
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0020
Practice Address - Country:US
Practice Address - Phone:443-287-2030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR158480363L00000X
WAAP30007541363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD406387200Medicaid
MDKR70K069Medicare ID - Type Unspecified
MDQ30142Medicare UPIN