Provider Demographics
NPI:1811700727
Name:TUCCI-CLARK, NATALIE MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:MARIE
Last Name:TUCCI-CLARK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2331 YORK RD STE 100
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-2246
Mailing Address - Country:US
Mailing Address - Phone:410-823-6408
Mailing Address - Fax:
Practice Address - Street 1:158 FRONT ROYAL PIKE STE 206
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22602-4324
Practice Address - Country:US
Practice Address - Phone:667-220-0170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-27
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical