Healthcare Provider Details

I. General information

NPI: 1619801339
Provider Name (Legal Business Name): JAHI TRACY NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE
BOSTON MA
02115-5724
US

IV. Provider business mailing address

655 WASHINGTON ST APT 209
WEYMOUTH MA
02188-3446
US

V. Phone/Fax

Practice location:
  • Phone: 617-515-5430
  • Fax:
Mailing address:
  • Phone: 617-515-5430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberRN10006539
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: