Basic Information
| Provider Information | |||||||||
| NPI: | 1255345849 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUTHRIE | ||||||||
| FirstName: | TRACEY | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 345 BLACKSTONE BLVD | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029064800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014556200 | ||||||||
| FaxNumber: | 4014556293 | ||||||||
| Practice Location | |||||||||
| Address1: | 345 BLACKSTONE BLVD | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029064800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014556200 | ||||||||
| FaxNumber: | 4014556293 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2006 | ||||||||
| LastUpdateDate: | 07/03/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | MD09580 | RI | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 1093831646 | 01 | BUTLER HOSPITAL PROFESSIONAL BILLING OFFICE | OTHER | 1104801349 | 01 | RI | BUTLER HOSPITAL NPI | OTHER | 405684 | 01 | RI | BLUE CHIP | OTHER | 15-11636 | 01 | RI | UNITED BEHAVIORAL HEALTH | OTHER | 20853-4 | 01 | RI | BLUE CROSS BLUE SHIELD | OTHER | P00402004 | 01 | RI | MEDICARE RAILROAD | OTHER | 7007147 | 05 | RI | MEDICAID | 02246371 | 05 | NY | MEDICAID |