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General NPI Number Information
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NPI Number | 1396899282
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Entity Type | Individual
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Provider Name | TRACEY JEANNETTE WILES DO
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Gender | Female
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 10/29/2021
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Provider Practice Location Address
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Address Line | 1598 E MAIN ST
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City | TORRINGTON
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State | CT
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Zip | 06790-3519
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Country | US
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Telephone | 860-489-8444
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Fax | 860-496-8641
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Provider Business Mailing Address
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Address Line | PO BOX 1090
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City | WINDSOR
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State | CT
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Zip | 06095-6190
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Country | US
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Telephone | 203-709-5935
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Fax | 203-709-5942
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 000270
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License Number State | CT
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