Healthcare Provider Details

I. General information

NPI: 1225020316
Provider Name (Legal Business Name): DAVID MEARS TRACY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 02/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 VILLAGE SQ
CHELMSFORD MA
01824-2712
US

IV. Provider business mailing address

19 VILLAGE SQ
CHELMSFORD MA
01824-2712
US

V. Phone/Fax

Practice location:
  • Phone: 978-256-5600
  • Fax: 978-703-0250
Mailing address:
  • Phone: 978-256-5600
  • Fax: 978-703-0250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number32363
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: