Healthcare Provider Details

I. General information

NPI: 1629088893
Provider Name (Legal Business Name): TRACY B WRIGHT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 09/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 FIRST COLONIAL RD SUITE 300
VIRGINIA BEACH VA
23454-2406
US

IV. Provider business mailing address

1080 FIRST COLONIAL RD SUITE 300
VIRGINIA BEACH VA
23454-2406
US

V. Phone/Fax

Practice location:
  • Phone: 757-481-7222
  • Fax: 757-496-3772
Mailing address:
  • Phone: 757-481-7222
  • Fax: 757-496-3772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number010154328
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: