Healthcare Provider Details

I. General information

NPI: 1881815603
Provider Name (Legal Business Name): MICHELE K. TRAZKOVICH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHELLEY K. TRAZKOVICH M.D.

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 SUNDAY CT.
REISTERSTOWN MD
21136-6111
US

IV. Provider business mailing address

17 SUNDAY CT.
REISTERSTOWN MD
21136-6111
US

V. Phone/Fax

Practice location:
  • Phone: 410-526-2809
  • Fax: 410-526-2809
Mailing address:
  • Phone: 410-526-2809
  • Fax: 410-526-2809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0035400
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2084H0002X
TaxonomyHospice and Palliative Medicine (Psychiatry & Neurology) Physician
License NumberD0035400
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: