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NPI Code Detail

MEDICARE: TRACY HENDERSHOT MD

MEDICARE: TRACY HENDERSHOT MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician23784WV

General Provider Information

NPI Number : 1881855807
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACY HENDERSHOT MD
Provider Business Mailing Address
First Line : PO BOX 609
Second Line :
City : ELIZABETH
State : WV
Zip : 26143-0609
Country : US
Telephone Number : 304-275-3301
Fax Number : 304-275-4798
Provider Business Practice Location Address
First Line : 1301 ELIZABETH PIKE
Second Line :
City : ELIZABETH
State : WV
Zip : 26143-0609
Country : US
Telephone Number : 304-275-3301
Fax Number : 304-275-4798
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2008
Last Update Date : 04/07/2022

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