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General NPI Number Information
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NPI Number | 1164402053
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Entity Type | Individual
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Provider Name | ELMO GLENN TUCKER MD
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Gender | Male
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Dates
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Enumeration Date | 01/18/2006
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Last Update Date | 08/26/2015
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Provider Practice Location Address
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Address Line | 118 NORTHPORT AVE
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City | BELFAST
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State | ME
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Zip | 04915
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Country | US
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Telephone | 207-338-9324
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Fax | 207-338-6820
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Provider Business Mailing Address
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Address Line | P.O. BOX 287 118 NORTHPORT AVE
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City | BELFAST
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State | ME
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Zip | 04915
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Country | US
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Telephone | 207-338-9324
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Fax | 207-338-6820
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 029674
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License Number State | CT
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