Provider Demographics
NPI:1942270806
Name:CERNIGLIA, TRACY V (MD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:V
Last Name:CERNIGLIA
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 1:2 S CASCADE AVE
Mailing Address - Street 2:140
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1624
Mailing Address - Country:US
Mailing Address - Phone:719-838-2950
Mailing Address - Fax:719-538-2996
Practice Address - Street 1:6340 BARNES RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80922-2602
Practice Address - Country:US
Practice Address - Phone:719-596-2900
Practice Address - Fax:719-570-0601
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39488208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO81935218Medicaid
CO81935218Medicaid
441848Medicare ID - Type Unspecified