Provider Demographics
NPI:1992771133
Name:SAFIER, TRACIE M (MD)
Entity type:Individual
Prefix:
First Name:TRACIE
Middle Name:M
Last Name:SAFIER
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 1:255 W LANCASTER AVE
Mailing Address - Street 2:SUITE 330 PAOLI MOB III
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1763
Mailing Address - Country:US
Mailing Address - Phone:610-644-9233
Mailing Address - Fax:610-725-0938
Practice Address - Street 1:255 W LANCASTER AVE
Practice Address - Street 2:SUITE 330 PAOLI MOB III
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1763
Practice Address - Country:US
Practice Address - Phone:610-644-9233
Practice Address - Fax:610-725-0938
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD424565208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
I30337Medicare UPIN
PA232359401OtherMAIN LINE HEALTHCARE
PA188388HK1Medicare PIN