Provider Demographics
NPI:1730130832
Name:TUCKER, CATHERINE S (MD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:S
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:49 GOVERNORS AVE
Mailing Address - Street 2:HALLMARK HEALTH MEDICAL ASSOCIATES INC
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-3017
Mailing Address - Country:US
Mailing Address - Phone:781-395-6122
Mailing Address - Fax:781-395-2595
Practice Address - Street 1:49 GOVERNORS AVE
Practice Address - Street 2:HALLMARK HEALTH MEDICAL ASSOCIATES INC
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-3017
Practice Address - Country:US
Practice Address - Phone:781-395-6122
Practice Address - Fax:781-395-2595
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA793902086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3150640Medicaid
MA3150640Medicaid
G13198Medicare UPIN