Provider Demographics
NPI:1477725794
Name:TUCKER, MARGIE NICOLE LLOYD (MD)
Entity Type:Individual
Prefix:
First Name:MARGIE
Middle Name:NICOLE LLOYD
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 1:300 N GRAHAM ST STE 250
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1666
Mailing Address - Country:US
Mailing Address - Phone:503-280-3418
Mailing Address - Fax:503-284-7885
Practice Address - Street 1:300 N GRAHAM ST STE 250
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1666
Practice Address - Country:US
Practice Address - Phone:503-280-3418
Practice Address - Fax:503-284-7885
Is Sole Proprietor?:No
Enumeration Date:2008-03-26
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD610086812080P0202X
ORMD1962812080P0202X
IN01074034A2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2155531Medicaid
OR5007776428Medicaid