Provider Demographics
NPI:1598860702
Name:TUCKER, ANDREW MORRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:MORRIS
Last Name:TUCKER
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1407 YORK RD
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6097
Mailing Address - Country:US
Mailing Address - Phone:410-821-8062
Mailing Address - Fax:410-821-7047
Practice Address - Street 1:1407 YORK RD
Practice Address - Street 2:SUITE 100A
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6097
Practice Address - Country:US
Practice Address - Phone:410-821-8062
Practice Address - Fax:410-821-7047
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD50841204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE28218Medicare UPIN