MEDICARE: TRACY DEBIASO MD

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	207Q00000X	Family Medicine Physician	25MA06258600	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	F16382	OTHER	HEALTH NET
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	J3322	OTHER	HORIZON
4	1469012002	OTHER	CIGNA

General Provider Information

NPI Number	:	1831146802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY DEBIASO MD

Provider Business Mailing Address
First Line	:	230 LAUREL HEIGHTS DRIVE
Second Line	:
City	:	BRIDGETON
State	:	NJ
Zip	:	08302-3634
Country	:	US
Telephone Number	:	856-451-9595
Fax Number	:	856-451-4130

Provider Business Practice Location Address
First Line	:	230 LAUREL HEIGHTS DRIVE
Second Line	:
City	:	BRIDGETON
State	:	NJ
Zip	:	08302-3634
Country	:	US
Telephone Number	:	856-451-9595
Fax Number	:	856-451-4130

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

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	12/14/2010

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Directions to “ TRACY DEBIASO MD” Practice Location

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