Healthcare Provider Details

I. General information

NPI: 1275314148
Provider Name (Legal Business Name): LIV SPECIALTY CARE CT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10737 COLUMBIA PIKE
SILVER SPRING MD
20901-4401
US

IV. Provider business mailing address

PO BOX 53304
PHOENIX AZ
85072-3304
US

V. Phone/Fax

Practice location:
  • Phone: 240-332-1495
  • Fax:
Mailing address:
  • Phone: 844-614-2354
  • Fax: 844-278-8635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLES MICHAEL BUCY
Title or Position: SENIOR REIMBURSEMENT MANAGER
Credential:
Phone: 844-614-2354