Provider Demographics
NPI:1740282136
Name:TRACY, SHERRILL (MD)
Entity type:Individual
Prefix:
First Name:SHERRILL
Middle Name:
Last Name:TRACY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 PLEASANT STREET
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03570
Mailing Address - Country:US
Mailing Address - Phone:603-752-2040
Mailing Address - Fax:603-752-7797
Practice Address - Street 1:2 BROADWAY STREET
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:NH
Practice Address - Zip Code:03581
Practice Address - Country:US
Practice Address - Phone:603-466-2741
Practice Address - Fax:603-466-2953
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6910207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH6910OtherSTATE LICENSE #
NH81083242Medicaid
P00120775OtherRAILROAD MEDICARE
NH5635115001OtherCIGNA HEALTHCARE
NH0104864YPNH02OtherANTHEM BC/BS
NH0104864YPNH02OtherANTHEM BC/BS
NH0104864YPNH02OtherANTHEM BC/BS
NH3242Medicare ID - Type Unspecified