Provider Demographics
NPI:1073711768
Name:TUCKER, JAMELAH D (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMELAH
Middle Name:D
Last Name:TUCKER
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 1:1835 E HALLANDALE BEACH BLVD # 327
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4619
Mailing Address - Country:US
Mailing Address - Phone:786-530-7952
Mailing Address - Fax:
Practice Address - Street 1:800 WASHINGTON ST #286
Practice Address - Street 2:FLOATING HOSPITAL FOR CHILDREN AT TUFTS MEDICAL CENTER
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111
Practice Address - Country:US
Practice Address - Phone:978-788-7230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD66354208000000X
MA249948208000000X
FLME 107469208000000X
AK6712208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD412724200Medicaid
MD412724200Medicaid