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NPI Code Detail

MEDICARE: LORI TUCKER, DO PLLC

MEDICARE: LORI TUCKER, DO PLLC
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
1207V00000XObstetrics & Gynecology Physician1960WV

General Provider Information

NPI Number : 1558528018
Entity Type Code : Organization
Provider Name (Legal Business Name) : LORI TUCKER, DO PLLC
Provider Business Mailing Address
First Line : PO BOX 1138
Second Line :
City : PRINCETON
State : WV
Zip : 24740-1138
Country : US
Telephone Number : 304-431-7100
Fax Number :
Provider Business Practice Location Address
First Line : 904 HARRISON ST
Second Line :
City : PRINCETON
State : WV
Zip : 24740-3011
Country : US
Telephone Number : 304-431-7100
Fax Number :
Authorized Official
Title or Position : OWNER/PHYSICIAN
Name : LORI TUCKER
Credential : DO
Telephone Number : 304-431-7100
Provider Enumeration Date : 05/21/2008
Last Update Date : 05/21/2008

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