Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | D50841 | MD |
NPI | 1598860702 |
---|---|
Provider Name | Dr. Andrew Morris Tucker |
First Address | Lutherville, MD 21093-6097 |
Second Address | Lutherville, MD 21093-6097 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E28218 | (02) | MD |