Provider Demographics
NPI:1962418665
Name:ASAMOAH, TRACY (MD)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:ASAMOAH
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 1:1500 W UNIVERSITY AVE
Mailing Address - Street 2:STE. 103
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-7108
Mailing Address - Country:US
Mailing Address - Phone:512-868-1124
Mailing Address - Fax:
Practice Address - Street 1:1500 W UNIVERSITY AVE
Practice Address - Street 2:STE. 103
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-7108
Practice Address - Country:US
Practice Address - Phone:512-868-1124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2004-05072084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry