Healthcare Provider Details

I. General information

NPI: 1295885754
Provider Name (Legal Business Name): GINA MARTIN TRACHIMOWICZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 LAKE AVE N
WORCESTER MA
01655-0002
US

IV. Provider business mailing address

1 WASHBURN RD
AUBURN MA
01501-2320
US

V. Phone/Fax

Practice location:
  • Phone: 508-856-3590
  • Fax:
Mailing address:
  • Phone: 508-832-2335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number225567
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: