Provider Demographics
NPI:1578664462
Name:TUCKER, SUSAN MARY (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARY
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1 ESSEX CENTER DRIVE
Mailing Address - Street 2:LAHEY CLINIC
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-2901
Mailing Address - Country:US
Mailing Address - Phone:978-538-4400
Mailing Address - Fax:978-538-4724
Practice Address - Street 1:1 ESSEX CENTER DR
Practice Address - Street 2:LAHEY CLINIC
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2901
Practice Address - Country:US
Practice Address - Phone:978-538-4400
Practice Address - Fax:978-538-4724
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2016-05-04
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Provider Licenses
StateLicense IDTaxonomies
MA156646207W00000X, 207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110059835AMedicaid
MAF46936Medicare UPIN
MAF46936Medicare UPIN