Individual
JOSEPH W TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11 SOUTH RD, FARMINGTON, CT 06032-2483
(860) 679-1440
(860) 679-6465
Mailing address
263 FARMINGTON AVE, PROVIDER ENROLLMENT, FARMINGTON, CT 06030-2212
(860) 679-7503
(860) 679-1610
Taxonomy
Speciality
Code
Description
License number
State
207SG0201X
Clinical Genetics (M.D.) Physician
Primary
046663
CT
208000000X
Pediatrics Physician
046663
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316137060
—
CT
Enumeration date
07/30/2007
Last updated
09/20/2022
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