Provider Demographics
NPI:1841212248
Name:TUCKER, MARY GUERRY (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:GUERRY
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8700 STONY POINT PKWY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-1962
Mailing Address - Country:US
Mailing Address - Phone:804-323-0830
Mailing Address - Fax:
Practice Address - Street 1:8700 STONY POINT PKWY
Practice Address - Street 2:SUITE 220
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-1962
Practice Address - Country:US
Practice Address - Phone:804-323-0830
Practice Address - Fax:804-323-0829
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101041404207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4206810OtherAETNA
VA094393OtherANTHEM BC/BS
VA212119OtherCIGNA
VA6330223Medicaid
VA4206810OtherAETNA