MEDICARE: DR. TRACY PRINCE D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	OS010945L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2525814	OTHER	PA	CIGNA
2	7989331	OTHER	PA	AETNA
3	50097247	OTHER	PA	CAPITAL BC
4	1386391	OTHER	PA	HIGHMARK BS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	P010738	OTHER	PA	GATEWAY HEALTH PLAN

General Provider Information

NPI Number	:	1053335307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRACY PRINCE D.O.

Provider Business Mailing Address
First Line	:	2030 THISTLE HILL DR
Second Line	:
City	:	SPRING GROVE
State	:	PA
Zip	:	17362-1159
Country	:	US
Telephone Number	:	717-225-9869
Fax Number	:	717-225-6552

Provider Business Practice Location Address
First Line	:	2030 THISTLE HILL DR
Second Line	:	SUITE 100
City	:	SPRING GROVE
State	:	PA
Zip	:	17362-1159
Country	:	US
Telephone Number	:	717-225-9869
Fax Number	:	717-225-6552

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	03/17/2021

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Directions to “ DR. TRACY PRINCE D.O.” Practice Location

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