Healthcare Provider Details

I. General information

NPI: 1649233727
Provider Name (Legal Business Name): ROBERT W. BUCHANAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 10/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SPRING GROVE HOSPITAL GROUNDS MAPLE AND LOCUST STREETS
CATONSVILLE MD
21228
US

IV. Provider business mailing address

300 CONCERT WAY
CATONSVILLE MD
21228-5567
US

V. Phone/Fax

Practice location:
  • Phone: 410-402-7876
  • Fax: 410-402-7198
Mailing address:
  • Phone: 410-719-0073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0030807
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: