Individual
DR. TIA TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D., MPH
Contact information
Practice address
195 CANAL ST, MALDEN, MA 02148-6701
(781) 338-0500
Mailing address
195 CANAL ST, MALDEN, MA 02148-6701
(781) 338-0500
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
282887
MA
390200000X
Student in an Organized Health Care Education/Training Program
271861
MA
Other
Enumeration date
05/01/2017
Last updated
01/07/2021
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