| Robert J Trace Jr Md Pa | |
|
121 E Antietam St Hagerstown MD 21740-5601 | |
| (301) 739-2560 | |
| (301) 739-0266 |
| Full Name | Robert J Trace Jr Md Pa |
|---|---|
| Speciality | Internal Medicine - Gastroenterology |
| Location | 121 E Antietam St, Hagerstown, Maryland |
| Authorized Official Name and Position | Robert John Trace (PHYSICIAN/OWNER) |
| Authorized Official Contact | 3017392560 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Robert J Trace Jr Md Pa 121 E Antietam St Hagerstown MD 21740-5601 Ph: (301) 739-2560 | Robert J Trace Jr Md Pa 121 E Antietam St Hagerstown MD 21740-5601 Ph: (301) 739-2560 |
| NPI Number | 1043541147 |
|---|---|
| Provider Enumeration Date | 01/29/2010 |
| Last Update Date | 01/29/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043541147 | NPI | - | NPPES |
| 964111400MD | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | D22012 (Maryland) | Primary |
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