Healthcare Provider Details

I. General information

NPI: 1982973707
Provider Name (Legal Business Name): ASHURA BUCKLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2011
Last Update Date: 12/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CENTER DRIVE, MSC 1255 BUILDING 10, ROOM IC250
BETHESDA MD
20892
US

IV. Provider business mailing address

10 CENTER DRIVE BUILDING 10, ROOM IC250
BETHESDA MD
20814
US

V. Phone/Fax

Practice location:
  • Phone: 301-435-6650
  • Fax:
Mailing address:
  • Phone: 301-435-6650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberD0063849
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberD0063849
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: