MEDICARE: TINSLEY W RUCKER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0101258227	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467441592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINSLEY W RUCKER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 9007
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22906-9007
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2871 ROCKFISH VALLEY HIGHWAY
Second Line	:
City	:	NELLYSFORD
State	:	VA
Zip	:	22958
Country	:	US
Telephone Number	:	434-297-6000
Fax Number	:	434-297-6550

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	02/12/2024

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