Provider Demographics
NPI:1154532992
Name:ANSAY, TRACY L (MD)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:L
Last Name:ANSAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:375 BOYLSTON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-6007
Mailing Address - Country:US
Mailing Address - Phone:857-307-0869
Mailing Address - Fax:
Practice Address - Street 1:851 MAIN ST STE 11
Practice Address - Street 2:
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190
Practice Address - Country:US
Practice Address - Phone:781-331-0250
Practice Address - Fax:781-340-0506
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA254744207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery