Provider Demographics
NPI:1952564312
Name:SANCHEZ-VANHOOSE, TRACI ANNETTE (MD)
Entity type:Individual
Prefix:DR
First Name:TRACI
Middle Name:ANNETTE
Last Name:SANCHEZ-VANHOOSE
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:P.O. BOX 2379
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2379
Mailing Address - Country:US
Mailing Address - Phone:606-408-6200
Mailing Address - Fax:606-408-6612
Practice Address - Street 1:613 23RD ST STE G10
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2886
Practice Address - Country:US
Practice Address - Phone:606-408-5864
Practice Address - Fax:606-408-6499
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34749207R00000X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00673172OtherRR MEDICARE
KY64347495Medicaid
KYP01045719OtherRR MEDICARE
OH2119522Medicaid
OH2119522Medicaid
KY00772007Medicare PIN