Organization
SHADY GROVE ORTHOPAEDIC ASSOC, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEVEN L TUCK MD (PRESIDENT)
(301) 340-0072
Entity
Organization
Contact information
Practice address
9601 BLACKWELL ROAD SUITE 100, ROCKVILLE, MD 20850-3241
(301) 340-0072
(301) 279-9358
Mailing address
9601 BLACKWELL ROAD SUITE 100, ROCKVILLE, MD 20850-3241
(301) 340-0072
(301) 279-9358
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
D0002443
MD
Other
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
Enumeration date
02/23/2006
Last updated
10/23/2020
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