MEDICARE: DR. TRACY JANSEN 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	207Q00000X	Family Medicine Physician	D0062357	MD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
9	P00388727	OTHER	MD	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	132272	OTHER	MD	JHHC PROVIDER NUMBER
2	1438610	OTHER	MD	AETNA CAPITATED
3	3576324	OTHER		CIGNA PIN
4	646211-03	OTHER	MD	CAREFIRST MD RENDERING
5	7605-0088	OTHER	MD	CAREFIRST BLUECHOICE
6	8167140	OTHER	MD	MAMSI PRIMARY CARE
7	2167140	OTHER	MD	MAMSI SPECIALIST
8	P17639	OTHER	MD	CAREFIRST MD POS
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	5221541	OTHER	MD	AETNA FEE FOR SERVICE

General Provider Information

NPI Number	:	1922031210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRACY JANSEN M.D.

Provider Business Mailing Address
First Line	:	1111 BENFIELD BLVD
Second Line	:	SUITE 200
City	:	MILLERSVILLE
State	:	MD
Zip	:	21108-3002
Country	:	US
Telephone Number	:	410-729-5100
Fax Number	:	410-729-5156

Provider Business Practice Location Address
First Line	:	24A MAGOTHY BEACH RD
Second Line	:
City	:	PASADENA
State	:	MD
Zip	:	21122-4428
Country	:	US
Telephone Number	:	410-255-2700
Fax Number	:	410-437-1962

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

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	01/24/2011

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Directions to “ DR. TRACY JANSEN M.D.” Practice Location

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