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General NPI Number Information
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NPI Number | 1326234980
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Entity Type | Organization
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Legal Business Name | KENNETH K. TUCKER, M.D.
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Dates
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Enumeration Date | 09/18/2007
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Last Update Date | 09/18/2007
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Provider Practice Location Address
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Address Line | 15 DIX ST SUITE L
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City | WINCHESTER
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State | MA
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Zip | 01890-1870
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Country | US
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Telephone | 781-729-7294
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Fax |
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Provider Business Mailing Address
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Address Line | 15 DIX ST SUITE L
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City | WINCHESTER
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State | MA
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Zip | 01890-1870
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | PATRICIA A LANGELL
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Credential |
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Telephone | 781-729-7294
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 38617
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License Number State | MA
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