Provider Demographics
NPI:1538246590
Name:TUCKER, ROBERTA S (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:S
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1901 SULPHUR SPRING RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-2943
Mailing Address - Country:US
Mailing Address - Phone:410-536-1453
Mailing Address - Fax:410-536-1563
Practice Address - Street 1:1901 SULPHUR SPRING RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21227-2943
Practice Address - Country:US
Practice Address - Phone:410-536-1453
Practice Address - Fax:410-536-1563
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0018675207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology