MEDICARE: TRACIE KORTRIGHT

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
1	363A00000X	Physician Assistant	MA003611L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	970028712	OTHER	PA	MEDICARE-RAILROAD
2	054079	OTHER	PA	MEDICARE-DME

General Provider Information

NPI Number	:	1992779052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACIE KORTRIGHT

Provider Business Mailing Address
First Line	:	231 GRANITE RUN DR
Second Line	:
City	:	LANCASTER
State	:	PA
Zip	:	17601-6823
Country	:	US
Telephone Number	:	717-560-4200
Fax Number	:	717-560-4159

Provider Business Practice Location Address
First Line	:	170 N POINTE BLVD
Second Line	:
City	:	LANCASTER
State	:	PA
Zip	:	17601-4132
Country	:	US
Telephone Number	:	717-299-4871
Fax Number	:	717-391-2494

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	12/14/2020

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Directions to “ TRACIE KORTRIGHT ” Practice Location

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