Provider Demographics
NPI:1013942796
Name:TUCKER, SUSAN RONA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:RONA
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: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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT04200133572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VARI0536OtherVALUE OPTIONS
VA204451OtherANTHEM BLUE SHIELD
VA007109199Medicaid
VA204451OtherANTHEM BLUE SHIELD
VAC02301Medicare UPIN
VA260002489Medicare ID - Type Unspecified