Provider Demographics
NPI:1629104716
Name:TUCKER, DOROTHEA (MD)
Entity Type:Individual
Prefix:DR
First Name:DOROTHEA
Middle Name:
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 1:3026 WEAVER AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214-3401
Mailing Address - Country:US
Mailing Address - Phone:410-951-5000
Mailing Address - Fax:
Practice Address - Street 1:3445 BOX HILL CORPORATE CENTER DR
Practice Address - Street 2:E
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-1223
Practice Address - Country:US
Practice Address - Phone:410-515-3500
Practice Address - Fax:410-515-2504
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0029775207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDPENDINGMedicare UPIN