Provider Demographics
NPI:1043229503
Name:TUCKER, ABIGAIL MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:ABIGAIL
Middle Name:MARIE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9500 MENTOR AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-8714
Mailing Address - Country:US
Mailing Address - Phone:440-357-7100
Mailing Address - Fax:440-357-8132
Practice Address - Street 1:9500 MENTOR AVE STE 220
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-8714
Practice Address - Country:US
Practice Address - Phone:440-357-7100
Practice Address - Fax:440-357-8132
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-095029207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3097036Medicaid