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NPI Code Detail

MEDICARE: TRACI KALASKEY PA

MEDICARE: TRACI KALASKEY PA
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
1363A00000XPhysician Assistant00423WV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11069531OTHERWVWV DWC
2001718066OTHERWVWV BCBS

General Provider Information

NPI Number : 1265418651
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACI KALASKEY PA
Provider Business Mailing Address
First Line : 800 PENNSYLVANIA AVE
Second Line :
City : CHARLESTON
State : WV
Zip : 25302-3351
Country : US
Telephone Number : 304-388-2550
Fax Number : 304-388-2617
Provider Business Practice Location Address
First Line : 800 PENNSYLVANIA AVE
Second Line :
City : CHARLESTON
State : WV
Zip : 25302-3351
Country : US
Telephone Number : 304-388-2550
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2005
Last Update Date : 01/20/2017

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Directions to “ TRACI KALASKEY PA” Practice Location

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