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NPI Code Detail

MEDICARE: TRACEY MARIE DIXON

MEDICARE: TRACEY MARIE DIXON
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
1363LG0600XGerontology Nurse PractitionerSP020197PA
2207RG0100XGastroenterology PhysicianSP020197PA

General Provider Information

NPI Number : 1538726179
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACEY MARIE DIXON
Provider Business Mailing Address
First Line : 225 STRYJAK RD
Second Line :
City : MOUNTAIN TOP
State : PA
Zip : 18707-9381
Country : US
Telephone Number : 570-709-1953
Fax Number :
Provider Business Practice Location Address
First Line : 10 PARK PL
Second Line :
City : HAZLE TOWNSHIP
State : PA
Zip : 18202-2885
Country : US
Telephone Number : 570-454-1400
Fax Number : 570-454-2144
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2019
Last Update Date : 08/11/2025

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Directions to “ TRACEY MARIE DIXON ” Practice Location

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