Provider Demographics
NPI:1780769919
Name:TRACY, TODD CHRISTIAN (MD)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:CHRISTIAN
Last Name:TRACY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 COMMERCE PARK
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460
Mailing Address - Country:US
Mailing Address - Phone:203-878-3531
Mailing Address - Fax:203-876-2169
Practice Address - Street 1:40 COMMERCE PARK
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460
Practice Address - Country:US
Practice Address - Phone:203-878-3531
Practice Address - Fax:203-876-2169
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037452207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT01037452OtherNMO CIGNA
CT760889OtherHMO CONNECTICARE
CT1374529Medicaid
G89006Medicare UPIN
CT110007541Medicare ID - Type Unspecified