Provider Demographics
NPI:1699832493
Name:TUCKER, AMY L (MD)
Entity Type:Individual
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First Name:AMY
Middle Name:L
Last Name:TUCKER
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Gender:F
Credentials:MD
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Mailing Address - Street 1:90 PRESIDENTIAL PLZ
Mailing Address - Street 2:SUITE 5010
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-2240
Mailing Address - Country:US
Mailing Address - Phone:315-464-9335
Mailing Address - Fax:315-464-9338
Practice Address - Street 1:90 PRESIDENTIAL PLZ
Practice Address - Street 2:SUITE 5010
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-2240
Practice Address - Country:US
Practice Address - Phone:315-464-9335
Practice Address - Fax:315-464-9338
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2017-04-13
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Provider Licenses
StateLicense IDTaxonomies
NY287916207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAE64585Medicare UPIN