Healthcare Provider Details

I. General information

NPI: 1225254568
Provider Name (Legal Business Name): TRACY LYNN JALBUENA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 BRAMHALL ST
PORTLAND ME
04102-3134
US

IV. Provider business mailing address

110 FREE ST
PORTLAND ME
04101-3908
US

V. Phone/Fax

Practice location:
  • Phone: 207-706-3280
  • Fax: 207-810-2407
Mailing address:
  • Phone: 207-662-7300
  • Fax: 207-301-5288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number21060
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number57.012103
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD18220
License Number StateME
# 4
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberMD18220
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: