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General NPI Number Information
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NPI Number | 1154532992
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Entity Type | Individual
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Provider Name | TRACY L. ANSAY M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 06/18/2018
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Provider Practice Location Address
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Address Line | 851 MAIN ST STE 11
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City | SOUTH WEYMOUTH
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State | MA
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Zip | 02190
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Country | US
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Telephone | 781-331-0250
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Fax | 781-340-0506
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Provider Business Mailing Address
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Address Line | 375 BOYLSTON ST
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City | BROOKLINE
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State | MA
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Zip | 02445-6007
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Country | US
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Telephone | 857-307-0869
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 254744
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License Number State | MA
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