Healthcare Provider Details

I. General information

NPI: 1891769618
Provider Name (Legal Business Name): LUCY P. BUCKLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 12/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE
BOSTON MA
02115-5724
US

IV. Provider business mailing address

PO BOX 845628
BOSTON MA
02284-5628
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-6793
  • Fax:
Mailing address:
  • Phone: 603-893-9784
  • Fax: 603-893-8886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34323
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberMD06273
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: