Healthcare Provider Details

I. General information

NPI: 1073880076
Provider Name (Legal Business Name): WADE D BUCKLEY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2011
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LUMBER ST STE 101
HOPKINTON MA
01748-2364
US

IV. Provider business mailing address

9 INDUSTRIAL RD STE 5
MILFORD MA
01757-3736
US

V. Phone/Fax

Practice location:
  • Phone: 508-625-3535
  • Fax: 508-625-1973
Mailing address:
  • Phone: 508-473-1480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA4973
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: