Healthcare Provider Details

I. General information

NPI: 1871521260
Provider Name (Legal Business Name): TERESA L BUCKLES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6905 HOSPITAL DR STE 130
DUBLIN OH
43016-9600
US

IV. Provider business mailing address

PO BOX 7527
DUBLIN OH
43017-0727
US

V. Phone/Fax

Practice location:
  • Phone: 614-923-0300
  • Fax: 614-914-0400
Mailing address:
  • Phone: 419-520-2495
  • Fax: 614-544-6370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number50.000533
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.000533RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: