Provider Demographics
NPI:1538726179
Name:DIXON, TRACEY MARIE
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:MARIE
Last Name:DIXON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 STRYJAK RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN TOP
Mailing Address - State:PA
Mailing Address - Zip Code:18707-9381
Mailing Address - Country:US
Mailing Address - Phone:570-709-1953
Mailing Address - Fax:
Practice Address - Street 1:10 PARK PL
Practice Address - Street 2:
Practice Address - City:HAZLE TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18202-2885
Practice Address - Country:US
Practice Address - Phone:570-454-1400
Practice Address - Fax:570-454-2144
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP020197363LG0600X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology