Basic Information
Provider Information
NPI: 1225120579
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WRIGHT
FirstName: TRACY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 629
Address2: 601 ELMWOOD AVE
City: ROCHESTER
State: NY
PostalCode: 146420001
CountryCode: US
TelephoneNumber: 5857585700
FaxNumber: 5857581299
Practice Location
Address1: 2365 CLINTON AVE S
Address2: SUITE 200
City: ROCHESTER
State: NY
PostalCode: 146182663
CountryCode: US
TelephoneNumber: 5857585700
FaxNumber: 5857581299
Other Information
ProviderEnumerationDate: 09/28/2006
LastUpdateDate: 03/25/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000XF333914-1NYY Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


Home