Healthcare Provider Details

I. General information

NPI: 1831182302
Provider Name (Legal Business Name): MARIA DISALVO-TUCKMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 11/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S 7TH AVE SUITE 3170
WEST READING PA
19611-1410
US

IV. Provider business mailing address

PO BOX 13579
READING PA
19612-3579
US

V. Phone/Fax

Practice location:
  • Phone: 610-898-9380
  • Fax: 610-478-1170
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD050290L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: