Healthcare Provider Details

I. General information

NPI: 1093782153
Provider Name (Legal Business Name): JEFFRIES L.G. BUCCI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 04/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 OSLER DRIVE SUITE 310
TOWSON MD
21204-7702
US

IV. Provider business mailing address

7600 OSLER DRIVE SUITE 310
TOWSON MD
21204-7702
US

V. Phone/Fax

Practice location:
  • Phone: 410-296-2300
  • Fax: 410-296-3444
Mailing address:
  • Phone: 410-296-2300
  • Fax: 410-296-3444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0054956
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: