Healthcare Provider Details

I. General information

NPI: 1821500604
Provider Name (Legal Business Name): SUSAN R. TUCKER, MD,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2017
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 Number
License Number State

VIII. Authorized Official

Name: DR. SUSAN R TUCKER
Title or Position: OWNER
Credential: MD
Phone: 802-369-9378