Provider Demographics
NPI:1427285691
Name:TUCKER, SYREETA ALSTON (MD)
Entity type:Individual
Prefix:
First Name:SYREETA
Middle Name:ALSTON
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1541
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-1541
Mailing Address - Country:US
Mailing Address - Phone:252-492-8576
Mailing Address - Fax:252-492-7464
Practice Address - Street 1:1209 SE INDUSTRY DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27536
Practice Address - Country:US
Practice Address - Phone:252-492-8576
Practice Address - Fax:252-492-7464
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-01118207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology