Provider Demographics
NPI:1528122868
Name:GERALD F.TUCKER
Entity type:Organization
Organization Name:GERALD F.TUCKER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-310-2686
Mailing Address - Street 1:PO BOX 282
Mailing Address - Street 2:
Mailing Address - City:BOYDS
Mailing Address - State:MD
Mailing Address - Zip Code:20841-0282
Mailing Address - Country:US
Mailing Address - Phone:202-310-2686
Mailing Address - Fax:301-854-0120
Practice Address - Street 1:3460 OLNEY LAYTONSVILLE RD # 211-A
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1781
Practice Address - Country:US
Practice Address - Phone:202-310-2686
Practice Address - Fax:301-570-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
K560OtherBLUE CROSS BLUE SHIELD
MH33OtherBLUE CROSS BLUE SHIELD
MD1100860001Medicare NSC