Healthcare Provider Details

I. General information

NPI: 1174779946
Provider Name (Legal Business Name): DONNA CAROL BUCKLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 08/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR RD NW
WASHINGTON DC
20007-2113
US

IV. Provider business mailing address

610 PHEASANT ST
GAITHERSBURG MD
20878-3201
US

V. Phone/Fax

Practice location:
  • Phone: 202-444-2600
  • Fax: 202-444-4859
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberMD038626
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: