Organization
KENNETH K. TUCKER, M.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICIA A LANGELL (OFFICE MANAGER)
(781) 729-7294
Entity
Organization
Contact information
Practice address
15 DIX ST, SUITE L, WINCHESTER, MA 01890-1870
(781) 729-7294
Mailing address
15 DIX ST, SUITE L, WINCHESTER, MA 01890-1870
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
38617
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
038617
TUFTS
MA
05
—
2069172
—
MA
01
—
64462
HPHC
—
01
—
B54045
BCBS
—
Enumeration date
09/18/2007
Last updated
09/18/2007
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