Healthcare Provider Details

I. General information

NPI: 1144184813
Provider Name (Legal Business Name): EMILY ANN BUCKWALTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 W LINCOLN HWY
EXTON PA
19341-2514
US

IV. Provider business mailing address

650 W LINCOLN HWY
EXTON PA
19341-2514
US

V. Phone/Fax

Practice location:
  • Phone: 610-269-9966
  • Fax: 855-538-1737
Mailing address:
  • Phone: 610-269-9966
  • Fax: 855-538-1737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: