Provider Demographics
NPI:1467496075
Name:DILLON, TRACEY CALDWELL (BSRTR)
Entity type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:CALDWELL
Last Name:DILLON
Suffix:
Gender:F
Credentials:BSRTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:82 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:VA
Mailing Address - Zip Code:24127
Mailing Address - Country:US
Mailing Address - Phone:540-864-6786
Mailing Address - Fax:
Practice Address - Street 1:1900 BRAEBURN DR
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-7304
Practice Address - Country:US
Practice Address - Phone:540-774-8500
Practice Address - Fax:540-774-8310
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01200012762471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography