MEDICARE: TRACY A WHEELOCK M.D.

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	207VX0000X	Obstetrics Physician	0101048133	VA

General Provider Information

NPI Number	:	1518949510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY A WHEELOCK M.D.

Provider Business Mailing Address
First Line	:	114 NATIONWIDE DR
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24502-4271
Country	:	US
Telephone Number	:	434-239-7890
Fax Number	:	434-237-9222

Provider Business Practice Location Address
First Line	:	114 NATIONWIDE DR
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24502-4271
Country	:	US
Telephone Number	:	434-239-7890
Fax Number	:	434-237-9222

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

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	07/08/2007

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