Provider Demographics
NPI:1942372206
Name:MEATTEY, TRACY ELIZABETH (PA)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:ELIZABETH
Last Name:MEATTEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 NEW HAMPSHIRE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-2838
Mailing Address - Country:US
Mailing Address - Phone:603-431-2516
Mailing Address - Fax:603-431-9945
Practice Address - Street 1:25 NEW HAMPSHIRE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-2838
Practice Address - Country:US
Practice Address - Phone:603-431-2516
Practice Address - Fax:603-431-9945
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0729363AM0700X
RIPA00428363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3081273Medicaid
NHRAILROAD P01529796Medicare PIN
NH3081273Medicaid
NH30337579Medicaid