Healthcare Provider Details

I. General information

NPI: 1649529686
Provider Name (Legal Business Name): JAMES ANTHONY TRACY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2012
Last Update Date: 05/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 14TH ST NW
WASHINGTON DC
20009-6865
US

IV. Provider business mailing address

1220 12TH ST SE STE 120
WASHINGTON DC
20003-3733
US

V. Phone/Fax

Practice location:
  • Phone: 202-745-4300
  • Fax: 202-548-8600
Mailing address:
  • Phone: 202-715-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN1010195
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: