Provider Demographics
NPI:1871564724
Name:WEISBERG, TRACEY F (MD)
Entity type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:F
Last Name:WEISBERG
Suffix:
Gender:
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:PO BOX 911
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05302-0911
Mailing Address - Country:US
Mailing Address - Phone:207-303-3300
Mailing Address - Fax:207-250-2140
Practice Address - Street 1:11 ROCK ROW STE 120
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-4877
Practice Address - Country:US
Practice Address - Phone:207-303-3300
Practice Address - Fax:207-250-2139
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD12498207RH0003X
ME12498207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME6493249OtherCIGNA
ME002394OtherANTHEM BCBS
NH30004000OtherNH MEDICAID
ME301590099Medicaid
ME1041852OtherAETNA HMO
ME5574650OtherAETNA
ME5574650OtherAETNA
MEMM2732Medicare PIN
ME002394OtherANTHEM BCBS
ME6493249OtherCIGNA