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General NPI Number Information
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NPI Number | 1992834238
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Entity Type | Individual
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Provider Name | TRACEE BURROUGHS MD
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Gender | Female
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Dates
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Enumeration Date | 03/04/2007
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Last Update Date | 05/10/2012
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Provider Practice Location Address
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Address Line | 500 W 10TH ST
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City | WILMINGTON
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State | DE
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Zip | 19801-1422
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Country | US
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Telephone | 302-984-3380
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 64260
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City | BALTIMORE
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State | MD
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Zip | 21264-4260
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Country | US
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Telephone |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | D67250
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | C1-0009996
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License Number State | DE
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