Healthcare Provider Details

I. General information

NPI: 1720459605
Provider Name (Legal Business Name): MARIA ELIZABETH BUCHANAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2015
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 PINNACLE POINT DR
MIAMISBURG OH
45342-5015
US

IV. Provider business mailing address

PO BOX 643398
CINCINNATI OH
45264-3398
US

V. Phone/Fax

Practice location:
  • Phone: 937-886-5777
  • Fax: 937-886-5774
Mailing address:
  • Phone: 513-221-1100
  • Fax: 513-684-4501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.005076RX
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number50.005076RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: