Provider Demographics
NPI:1588848766
Name:RABIN, TRACY LYN (MD, SM)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:LYN
Last Name:RABIN
Suffix:
Gender:F
Credentials:MD, SM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:980 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06517-4032
Mailing Address - Country:US
Mailing Address - Phone:203-530-7487
Mailing Address - Fax:203-573-6707
Practice Address - Street 1:64 ROBBINS STREET, WATERBURY HOSPITAL CAMPUS, MAIN 3
Practice Address - Street 2:YALE PRIMARY CARE PROGRAM
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708
Practice Address - Country:US
Practice Address - Phone:203-573-6162
Practice Address - Fax:203-573-6707
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT048410207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics