Provider Demographics
NPI:1467441592
Name:RUCKER, TINSLEY W (MD)
Entity Type:Individual
Prefix:
First Name:TINSLEY
Middle Name:W
Last Name:RUCKER
Suffix:
Gender:M
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:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2871 ROCKFISH VALLEY HIGHWAY
Practice Address - Street 2:
Practice Address - City:NELLYSFORD
Practice Address - State:VA
Practice Address - Zip Code:22958
Practice Address - Country:US
Practice Address - Phone:434-297-6000
Practice Address - Fax:434-297-6550
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101258227207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8973827Medicaid
D92671Medicare UPIN
NC8973827Medicaid
NC211844DMedicare Oscar/Certification