Provider Demographics
NPI:1215932686
Name:BARRETT-TANGOREN, TRACY E (MD)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:E
Last Name:BARRETT-TANGOREN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2949 ERIE BLVD E
Mailing Address - Street 2:STE 110
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224-1442
Mailing Address - Country:US
Mailing Address - Phone:315-579-9037
Mailing Address - Fax:315-424-1779
Practice Address - Street 1:2949 ERIE BLVD E
Practice Address - Street 2:STE 110
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13224-1442
Practice Address - Country:US
Practice Address - Phone:315-579-9037
Practice Address - Fax:315-424-1779
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212177207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF69732Medicare UPIN
NYF69732Medicare UPIN
NY01943508Medicaid