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General NPI Number Information
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NPI Number | 1861208217
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Entity Type | Organization
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Legal Business Name | SILVER BIRCH MD LLC
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Dates
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Enumeration Date | 12/09/2024
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 15 PALOMBA DR
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City | ENFIELD
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State | CT
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Zip | 06082-3888
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Country | US
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Telephone | 860-951-2198
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Fax |
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Provider Business Mailing Address
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Address Line | 71 W STAFFORD RD STE 4A
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City | STAFFORD SPRINGS
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State | CT
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Zip | 06076-1069
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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 | OWNER/PHYSICIAN OWNER
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Name | IAN STERLING TUCKER
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Credential | MD
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Telephone | 860-951-2198
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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