Healthcare Provider Details

I. General information

NPI: 1770930851
Provider Name (Legal Business Name): MOLLIE BESS TUCKER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2016
Last Update Date: 04/30/2024
Certification Date: 11/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 CHESTNUT ST FL 11
PHILADELPHIA PA
19107-3612
US

IV. Provider business mailing address

1101 MARKET ST STE 2720
PHILADELPHIA PA
19107-2934
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-7785
  • Fax: 215-503-4442
Mailing address:
  • Phone: 215-955-7785
  • Fax: 215-503-4442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number62538
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMD477339
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: