Healthcare Provider Details

I. General information

NPI: 1255358917
Provider Name (Legal Business Name): CHRISTOPHER S BUCKLEY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4439 STATE ROUTE 159 STE 120
CHILLICOTHEE OH
45601-8207
US

IV. Provider business mailing address

272 HOSPITAL RD STE 6
CHILLICOTHEE OH
45601-9031
US

V. Phone/Fax

Practice location:
  • Phone: 740-779-7270
  • Fax: 740-779-7279
Mailing address:
  • Phone: 740-779-4275
  • Fax: 740-779-4257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number34.006923
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: