Healthcare Provider Details

I. General information

NPI: 1679698344
Provider Name (Legal Business Name): JAMES RUSSELL BUCK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 01/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 N CHARLES ST STE 305
BALTIMORE MD
21204-6800
US

IV. Provider business mailing address

PO BOX 64563
BALTIMORE MD
21264-4563
US

V. Phone/Fax

Practice location:
  • Phone: 443-849-6201
  • Fax: 443-849-6280
Mailing address:
  • Phone: 410-933-7440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberD0016954
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: