Provider Demographics
NPI:1285781716
Name:DLOTT, TRACY RUBIN (MD)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:RUBIN
Last Name:DLOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2101 EAST JEFFERSON STREET
Mailing Address - Street 2:PPQA MEDICARE COMPLIANCE UNIT 6 WEST KAISER PERMANENTE
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-6660
Mailing Address - Fax:301-816-6308
Practice Address - Street 1:12255 FAIRLAKES PKWY.
Practice Address - Street 2:
Practice Address - City:FAIFAX
Practice Address - State:VA
Practice Address - Zip Code:22033
Practice Address - Country:US
Practice Address - Phone:703-934-5269
Practice Address - Fax:703-934-5280
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101239279207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G24746Medicare UPIN
019076K92Medicare ID - Type Unspecified