Provider Demographics
NPI:1760455067
Name:TUCKER, MARC S (DO)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:S
Last Name:TUCKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:841 HOSPITAL ROAD
Mailing Address - Street 2:SUITE 2300 MARC S TUCKER DO FACOS
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701
Mailing Address - Country:US
Mailing Address - Phone:724-463-1512
Mailing Address - Fax:724-463-1541
Practice Address - Street 1:841 HOSPITAL ROAD
Practice Address - Street 2:SUITE 2300 MARC S TUCKER DO FACOS
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701
Practice Address - Country:US
Practice Address - Phone:724-463-1512
Practice Address - Fax:724-463-1541
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005464L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PATU1655957OtherHIGHMARK
PA1011452480001Medicaid
PA1011452480001Medicaid
C53778Medicare UPIN