Provider Demographics
NPI:1972721397
Name:MULLARE, TRACY (MD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:MULLARE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:940 BELMONT ST
Mailing Address - Street 2:BUILDING 7, 2ND FLOOR
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-5596
Mailing Address - Country:US
Mailing Address - Phone:508-864-8425
Mailing Address - Fax:508-894-8450
Practice Address - Street 1:940 BELMONT ST
Practice Address - Street 2:BUILDING 7, 2ND FLOOR
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5596
Practice Address - Country:US
Practice Address - Phone:508-864-8425
Practice Address - Fax:508-894-8450
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD864292084P0804X
MA2371752084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry