Provider Demographics
NPI:1891708665
Name:HARK, WILLIAM TUCKER (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:TUCKER
Last Name:HARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9920 INDEPENDENCE PARK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1487
Mailing Address - Country:US
Mailing Address - Phone:804-285-7420
Mailing Address - Fax:804-565-3736
Practice Address - Street 1:9920 INDEPENDENCE PARK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-1487
Practice Address - Country:US
Practice Address - Phone:804-285-7420
Practice Address - Fax:804-565-3736
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101051636207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA223269OtherANTHEM
VA5808367Medicaid
VA5808367Medicaid