Provider Demographics
NPI:1205332772
Name:TRACY, ERIN MACKENZIE (DO)
Entity type:Individual
Prefix:DR
First Name:ERIN
Middle Name:MACKENZIE
Last Name:TRACY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3590 BUSENBARK RD STE 400
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:OH
Mailing Address - Zip Code:45067-9602
Mailing Address - Country:US
Mailing Address - Phone:139-886-3695
Mailing Address - Fax:513-869-4624
Practice Address - Street 1:3590 BUSENBARK RD STE 400
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:OH
Practice Address - Zip Code:45067-9602
Practice Address - Country:US
Practice Address - Phone:513-988-6369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-03
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT0142207Q00000X
OH390200000X
OH34.017268207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty