Provider Demographics
NPI:1790540987
Name:TUCKER, DERRICK H JR
Entity Type:Individual
Prefix:
First Name:DERRICK
Middle Name:H
Last Name:TUCKER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2902 O ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-3617
Mailing Address - Country:US
Mailing Address - Phone:202-679-2984
Mailing Address - Fax:
Practice Address - Street 1:2902 O ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-3617
Practice Address - Country:US
Practice Address - Phone:202-679-2984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator