Provider Demographics
NPI:1821500604
Name:SUSAN R. TUCKER, MD,P.C.
Entity Type:Organization
Organization Name:SUSAN R. TUCKER, MD,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-369-9378
Mailing Address - Street 1:PO BOX 252
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:VT
Mailing Address - Zip Code:05055-0252
Mailing Address - Country:US
Mailing Address - Phone:802-369-9378
Mailing Address - Fax:802-649-7217
Practice Address - Street 1:221 ROUTE 5 S
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:VT
Practice Address - Zip Code:05055-9523
Practice Address - Country:US
Practice Address - Phone:802-369-9378
Practice Address - Fax:802-649-7217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-01
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty