Healthcare Provider Details

I. General information

NPI: 1972644508
Provider Name (Legal Business Name): JEFFREY A BUCCI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 03/15/2024
Certification Date: 03/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 LINDALL ST
DANVERS MA
01923-2121
US

IV. Provider business mailing address

75 LINDALL ST
DANVERS MA
01923-2121
US

V. Phone/Fax

Practice location:
  • Phone: 978-767-2847
  • Fax: 978-705-6436
Mailing address:
  • Phone: 978-767-2847
  • Fax: 978-978-7056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number238671
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number238671
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: