Healthcare Provider Details

I. General information

NPI: 1841212248
Provider Name (Legal Business Name): MARY GUERRY TUCKER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 11/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 STONY POINT PKWY SUITE 220
RICHMOND VA
23235-1962
US

IV. Provider business mailing address

8700 STONY POINT PKWY SUITE 220
RICHMOND VA
23235-1962
US

V. Phone/Fax

Practice location:
  • Phone: 804-323-0830
  • Fax: 804-323-0829
Mailing address:
  • Phone: 804-323-0830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101041404
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: