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General NPI Number Information
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NPI Number | 1669448437
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Entity Type | Organization
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Legal Business Name | SHADY GROVE ORTHOPAEDIC ASSOC, PA
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Dates
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Enumeration Date | 02/23/2006
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Last Update Date | 10/23/2020
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Provider Practice Location Address
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Address Line | 9601 BLACKWELL ROAD SUITE 100
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City | ROCKVILLE
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State | MD
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Zip | 20850-3241
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Country | US
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Telephone | 301-340-0072
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Fax | 301-279-9358
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Provider Business Mailing Address
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Address Line | 9601 BLACKWELL ROAD SUITE 100
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City | ROCKVILLE
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State | MD
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Zip | 20850-3241
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Country | US
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Telephone | 301-340-0072
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Fax | 301-279-9358
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. STEVEN L TUCK
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Credential | MD
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Telephone | 301-340-0072
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | D0002443
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License Number State | MD
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