Leigh Tracy, | |
250 N Calvert St Lowr Level, Baltimore, MD 21202-3505 | |
(410) 332-4847 | |
Not Available |
Full Name | Leigh Tracy |
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Gender | Female |
Speciality | Dietitian, Registered |
Location | 250 N Calvert St Lowr Level, Baltimore, Maryland |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1013461334 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
133V00000X | Dietitian, Registered | 86041185 (Maryland) | Primary |
Provider Name | St. Agnes Healthcare, Inc. |
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Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1144250176 PECOS PAC ID: 9830092733 Enrollment ID: O20040128001146 |
Mailing Address | Practice Location Address |
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Leigh Tracy, 250 N Calvert St Lowr Level, Baltimore, MD 21202-3505 Ph: (410) 332-4847 | Leigh Tracy, 250 N Calvert St Lowr Level, Baltimore, MD 21202-3505 Ph: (410) 332-4847 |
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