Robert J Trace Jr MD PA

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

D22012 Issued in MD

Legal business name

ROBERT J TRACE JR MD PA

Practice address

121 E Antietam St
Hagerstown, MD 21740-5601

Phone

(301) 739-2560

Fax

(301) 739-0266

NPI assigned

Jan 29, 2010

Last updated

Jan 29, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Robert John Trace Jr., MD

Title

Physician/Owner

Phone

(301) 739-2560

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1264723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1264723200000",
    "number": "1043541147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 E ANTIETAM ST",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217405601",
            "telephone_number": "301-739-2560",
            "fax_number": "301-739-0266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 E ANTIETAM ST",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217405601",
            "telephone_number": "301-739-2560",
            "fax_number": "301-739-0266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT J TRACE JR MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-29",
        "last_updated": "2010-01-29",
        "status": "A",
        "authorized_official_last_name": "TRACE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "301-739-2560",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MD",
            "license": "D22012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "964111400MD",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Gastroenterology Physician in Hagerstown, MD
• Providers in Hagerstown, MD by specialty
• Gastroenterology Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.