Provider Demographics
NPI:1861464695
Name:TUCKEY-LARUS, CORINNE NANCY (MD)
Entity Type:Individual
Prefix:
First Name:CORINNE
Middle Name:NANCY
Last Name:TUCKEY-LARUS
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 1:1212 KOGER CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4778
Mailing Address - Country:US
Mailing Address - Phone:804-897-2100
Mailing Address - Fax:804-897-9074
Practice Address - Street 1:1212 KOGER CENTER BLVD
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4778
Practice Address - Country:US
Practice Address - Phone:804-897-2100
Practice Address - Fax:804-897-9074
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101046707207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6200648Medicaid
F07464Medicare UPIN
160000923Medicare ID - Type Unspecified