Healthcare Provider Details

I. General information

NPI: 1013942796
Provider Name (Legal Business Name): SUSAN RONA TUCKER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 ROUTE 5 S
NORWICH VT
05055-9523
US

IV. Provider business mailing address

PO BOX 252
NORWICH VT
05055-0252
US

V. Phone/Fax

Practice location:
  • Phone: 802-369-9378
  • Fax: 802-649-7217
Mailing address:
  • Phone: 802-369-9378
  • Fax: 802-649-7217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0420013357
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: