Healthcare Provider Details

I. General information

NPI: 1811700727
Provider Name (Legal Business Name): NATALIE MARIE TUCCI-CLARK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 FRONT ROYAL PIKE STE 206
WINCHESTER VA
22602-4324
US

IV. Provider business mailing address

2331 YORK RD STE 100
TIMONIUM MD
21093-2246
US

V. Phone/Fax

Practice location:
  • Phone: 667-220-0170
  • Fax:
Mailing address:
  • Phone: 410-823-6408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: