Provider Demographics
NPI:1952416612
Name:TUCKER, STEVEN RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:RICHARD
Last Name:TUCKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9001 DIGGES RD STE 206
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4414
Mailing Address - Country:US
Mailing Address - Phone:703-330-6440
Mailing Address - Fax:703-369-5819
Practice Address - Street 1:9001 DIGGES RD STE 206
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4414
Practice Address - Country:US
Practice Address - Phone:703-330-6440
Practice Address - Fax:703-369-5819
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101043908207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7212-0001OtherCAREFIRST BLUECHOICE
VA5603641Medicaid
VA100025OtherANTHEM BLUE SHIELD
VA080004199Medicare ID - Type Unspecified
VA7212-0001OtherCAREFIRST BLUECHOICE