Provider Demographics
NPI:1841428133
Name:TUCKER, JAMES RORY JUDSON (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:RORY JUDSON
Last Name:TUCKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 N BROAD ST STE 4
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19121-3429
Mailing Address - Country:US
Mailing Address - Phone:215-204-7500
Mailing Address - Fax:215-204-4660
Practice Address - Street 1:1700 N BROAD ST STE 4
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19121-3429
Practice Address - Country:US
Practice Address - Phone:215-204-7500
Practice Address - Fax:215-204-4660
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD445215207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA262272Medicare PIN