Healthcare Provider Details

I. General information

NPI: 1215433750
Provider Name (Legal Business Name): NIALL ANTHONY BUCKLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 ASHTON DR STE 200
WILMINGTON NC
28412-2486
US

IV. Provider business mailing address

6509 RIVER VISTA DR
WILMINGTON NC
28412-2983
US

V. Phone/Fax

Practice location:
  • Phone: 910-799-2262
  • Fax: 910-799-2943
Mailing address:
  • Phone: 910-799-2262
  • Fax: 910-799-2943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number2026-04523
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: