Provider Demographics
NPI:1427056183
Name:JONES, TRACEY N (MD)
Entity type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:N
Last Name:JONES
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 1:439 JENNICK DR
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-4901
Mailing Address - Country:US
Mailing Address - Phone:804-524-0890
Mailing Address - Fax:804-524-0897
Practice Address - Street 1:439 JENNICK DR
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-4901
Practice Address - Country:US
Practice Address - Phone:804-524-0890
Practice Address - Fax:804-524-0897
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049908207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6214878Medicaid
VA541941044OtherEIN
VAC06165Medicare PIN
VA6214878Medicaid
VAF88500Medicare UPIN