MEDICARE: DR. KEITH T TRACY M.D.

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	227369	MA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	AA62481	OTHER	MA	HARVARD PILGRIM
3	494983	OTHER	MA	TUFTS HEALTH PLAN
4	1238590	OTHER	MA	AETNA
5	J40295	OTHER	MA	BLUE SHIELD
6	116191	OTHER	MA	FALLON
7	1847716	OTHER	MA	CIGNA

NPI Number	:	1477511871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEITH T TRACY M.D.

Provider Business Mailing Address
First Line	:	780 MAIN ST
Second Line	:
City	:	S WEYMOUTH
State	:	MA
Zip	:	02190-1622
Country	:	US
Telephone Number	:	781-331-4600
Fax Number	:	781-337-5095

Provider Business Practice Location Address
First Line	:	780 MAIN ST
Second Line	:
City	:	S WEYMOUTH
State	:	MA
Zip	:	02190-1622
Country	:	US
Telephone Number	:	781-331-4600
Fax Number	:	781-337-5095

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	01/04/2016

8200 DODGE STREET , CHILDREN'S HOSPITAL & MEDICARE CENTER
OMAHA, NE
68114-4113

Practice Phone: 402-955-6140
Practice Fax: 402-955-3398

780 MAIN ST , SUITE 2A
SOUTH WEYMOUTH, MA
02190-1622

Practice Phone: 781-335-4815
Practice Fax: 781-337-9651

780 MAIN ST
SOUTH WEYMOUTH, MA
02190-1622