Provider Demographics
NPI:1265536429
Name:CHUNN, TRACEY L (MD)
Entity type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:L
Last Name:CHUNN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3100 WYMAN PARK DRIVE
Mailing Address - Street 2:SUITE 359A
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211
Mailing Address - Country:US
Mailing Address - Phone:410-338-3016
Mailing Address - Fax:410-338-3420
Practice Address - Street 1:1000 E EAGER STREET
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202
Practice Address - Country:US
Practice Address - Phone:410-502-8494
Practice Address - Fax:410-955-7128
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD52215207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD699216100Medicaid
H23954Medicare UPIN
MD699216100Medicaid