Healthcare Provider Details

I. General information

NPI: 1609409606
Provider Name (Legal Business Name): ERICA ELIZABETH MARTINEZ-BUCKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERICA BUCKI

II. Dates (important events)

Enumeration Date: 02/18/2020
Last Update Date: 09/30/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4494 PALMER RD NORTH
BETHESDA MD
20814
US

IV. Provider business mailing address

4494 PALMER RD NORTH
BETHESDA MD
20814
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-4000
  • Fax:
Mailing address:
  • Phone: 301-295-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number78192
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: