Provider Demographics
NPI:1124062104
Name:TUCK, STEVEN L (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:L
Last Name:TUCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7614 MARYKNOLL AVE
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-4854
Mailing Address - Country:US
Mailing Address - Phone:301-229-4755
Mailing Address - Fax:
Practice Address - Street 1:9601 BLACKWELL RD STE 100
Practice Address - Street 2:SHADY GROVE ORTHOPAEDICS
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6477
Practice Address - Country:US
Practice Address - Phone:301-340-9200
Practice Address - Fax:301-340-6934
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2023-11-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0025078174400000X, 207X00000X, 207XS0106X, 207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC62494Medicare UPIN
MD402226S16Medicare PIN