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NPI Code Detail

MEDICARE: DR. TRACY LYNN JALBUENA MD

MEDICARE: DR. TRACY LYNN JALBUENA MD
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
1261QU0200XUrgent Care Clinic/Center21060NH
2207P00000XEmergency Medicine Physician57.012103OH
3207P00000XEmergency Medicine PhysicianMD18220ME
4261QU0200XUrgent Care Clinic/CenterMD18220ME

General Provider Information

NPI Number : 1225254568
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TRACY LYNN JALBUENA MD
Provider Business Mailing Address
First Line : 110 FREE ST
Second Line :
City : PORTLAND
State : ME
Zip : 04101-3908
Country : US
Telephone Number : 207-662-7300
Fax Number : 207-301-5288
Provider Business Practice Location Address
First Line : 22 BRAMHALL ST
Second Line :
City : PORTLAND
State : ME
Zip : 04102-3134
Country : US
Telephone Number : 207-706-3280
Fax Number : 207-810-2407
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2007
Last Update Date : 12/02/2025

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