# SHADY GROVE ORTHOPAEDIC ASSOC, PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669448437
- **Authorized official:** MR. STEVEN L TUCK MD (PRESIDENT)
- **Authorized official phone:** (301) 340-0072

## Contact information

- **Practice address:** 9601 BLACKWELL ROAD SUITE 100, ROCKVILLE, MD 20850-3241
- **Practice address phone:** (301) 340-0072
- **Practice address fax:** (301) 279-9358
- **Mailing address:** 9601 BLACKWELL ROAD SUITE 100, ROCKVILLE, MD 20850-3241
- **Mailing address phone:** (301) 340-0072
- **Mailing address fax:** (301) 279-9358

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | D0002443 | MD | Yes |

## Other

- **Enumeration date:** 02/23/2006
- **Last updated:** 10/23/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0549770001 | ADMINISTAR FEDERAL | MD |
| 01 | — | 225292 | MAMSI | MD |
| 01 | — | 4661 | BLUE SHIELD OF NCA | MD |
| 01 | — | C10224 | MEDICARE RAILROAD | MD |
| 01 | — | H840SH | BLUE SHIELD OF MARYLAND | MD |