Provider Demographics
NPI:1275694473
Name:TUCKER-POWELL, DANITA LORRAINE (MD)
Entity Type:Individual
Prefix:
First Name:DANITA
Middle Name:LORRAINE
Last Name:TUCKER-POWELL
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 1:7525 GREENWAY CENTER DRIVE SUITE 110
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770
Mailing Address - Country:US
Mailing Address - Phone:301-220-1200
Mailing Address - Fax:301-474-5590
Practice Address - Street 1:7525 GREENWAY CENTER DRIVE SUITE 110
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770
Practice Address - Country:US
Practice Address - Phone:301-220-1200
Practice Address - Fax:301-474-5590
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0050900208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD797700000Medicaid