MEDICARE: TRACY WRIGHT NP

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	208000000X	Pediatrics Physician	F333914-1	NY

General Provider Information

NPI Number	:	1225120579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY WRIGHT NP

Provider Business Mailing Address
First Line	:	PO BOX 629
Second Line	:	601 ELMWOOD AVE
City	:	ROCHESTER
State	:	NY
Zip	:	14642-0001
Country	:	US
Telephone Number	:	585-758-5700
Fax Number	:	585-758-1299

Provider Business Practice Location Address
First Line	:	2365 CLINTON AVE S
Second Line	:	SUITE 200
City	:	ROCHESTER
State	:	NY
Zip	:	14618-2663
Country	:	US
Telephone Number	:	585-758-5700
Fax Number	:	585-758-1299

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

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	03/25/2013

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