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NPI Code Detail

MEDICARE: SARA S TUCKER MD

MEDICARE:   SARA S TUCKER  MD
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
12084P0800XPsychiatry Physician23781OH

General Provider Information

NPI Number : 1881752749
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARA S TUCKER MD
Provider Business Mailing Address
First Line : 2701 FAIRFAX RD
Second Line :
City : CLEVELAND HTS
State : OH
Zip : 44118-4011
Country : US
Telephone Number : 216-932-1300
Fax Number : 216-932-5671
Provider Business Practice Location Address
First Line : 2701 FAIRFAX RD
Second Line :
City : CLEVELAND HTS
State : OH
Zip : 44118-4011
Country : US
Telephone Number : 216-932-1300
Fax Number : 216-932-5671
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2006
Last Update Date : 03/11/2008

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Directions to “ SARA S TUCKER MD” Practice Location

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