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NPI Code Detail

MEDICARE: DR. TRACEY A VIOLA D.O.

MEDICARE: DR. TRACEY A VIOLA D.O.
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
1207QS0010XSports Medicine (Family Medicine) Physician254422NY

General Provider Information

NPI Number : 1679732473
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TRACEY A VIOLA D.O.
Provider Business Mailing Address
First Line : 203 OLD MILITARY ROAD, PO BOX 790
Second Line : LAKE PLACID SPORTS MEDICINE
City : LAKE PLACID
State : NY
Zip : 12946
Country : US
Telephone Number : 518-523-1327
Fax Number : 518-523-9964
Provider Business Practice Location Address
First Line : 203 OLD MILITARY RD
Second Line :
City : LAKE PLACID
State : NY
Zip : 12946-1738
Country : US
Telephone Number : 518-523-1327
Fax Number : 518-523-9964
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2008
Last Update Date : 02/18/2019

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Directions to “ DR. TRACEY A VIOLA D.O.” Practice Location

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