Provider Demographics
NPI:1801145750
Name:BINGAMAN, TRACY E (PA-C)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:E
Last Name:BINGAMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:E
Other - Last Name:GOULD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1941 HAMILTON ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-6470
Mailing Address - Country:US
Mailing Address - Phone:484-426-2900
Mailing Address - Fax:484-426-2907
Practice Address - Street 1:1941 HAMILTON ST
Practice Address - Street 2:SUITE 102
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-6470
Practice Address - Country:US
Practice Address - Phone:484-426-2900
Practice Address - Fax:484-426-2907
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055709363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant