MEDICARE: JAMES RORY JUDSON TUCKER 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	MD445215	PA

General Provider Information

NPI Number	:	1841428133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES RORY JUDSON TUCKER M.D.

Provider Business Mailing Address
First Line	:	1700 N BROAD ST STE 4
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19121-3429
Country	:	US
Telephone Number	:	215-204-7500
Fax Number	:	215-204-4660

Provider Business Practice Location Address
First Line	:	1700 N BROAD ST STE 4
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19121-3429
Country	:	US
Telephone Number	:	215-204-7500
Fax Number	:	215-204-4660

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

Provider Enumeration Date	:	06/25/2009
Last Update Date	:	08/12/2025

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