Healthcare Provider Details

I. General information

NPI: 1881752749
Provider Name (Legal Business Name): SARA S TUCKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 FAIRFAX RD
CLEVELAND HTS OH
44118-4011
US

IV. Provider business mailing address

2701 FAIRFAX RD
CLEVELAND HTS OH
44118-4011
US

V. Phone/Fax

Practice location:
  • Phone: 216-932-1300
  • Fax: 216-932-5671
Mailing address:
  • Phone: 216-932-1300
  • Fax: 216-932-5671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number23781
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: