Provider Demographics
NPI:1730157694
Name:CLARKE-LECONTE, TRACY-ANN M (MD)
Entity type:Individual
Prefix:DR
First Name:TRACY-ANN
Middle Name:M
Last Name:CLARKE-LECONTE
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 1:226 MILL HILL AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-2826
Mailing Address - Country:US
Mailing Address - Phone:203-863-3840
Mailing Address - Fax:203-863-3467
Practice Address - Street 1:5 PERRYRIDGE RD
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-4608
Practice Address - Country:US
Practice Address - Phone:203-863-3840
Practice Address - Fax:203-863-3467
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2358791207R00000X
CT041884208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT041884OtherCT PHYSICIAN LICENSE NO
CT041884OtherCT PHYSICIAN LICENSE NO
CT041884OtherCT PHYSICIAN LICENSE NO