Provider Demographics
NPI:1851402937
Name:RAZZAK TUCKER KAFONEK & HANSEN MD PA
Entity Type:Organization
Organization Name:RAZZAK TUCKER KAFONEK & HANSEN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-583-2630
Mailing Address - Street 1:10751 FALLS RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4517
Mailing Address - Country:US
Mailing Address - Phone:410-583-2630
Mailing Address - Fax:410-583-7186
Practice Address - Street 1:10751 FALLS RD
Practice Address - Street 2:SUITE 303
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-4517
Practice Address - Country:US
Practice Address - Phone:410-583-2630
Practice Address - Fax:410-583-7186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX IDENTIFICATION NUMBER