Healthcare Provider Details

I. General information

NPI: 1518155233
Provider Name (Legal Business Name): DAVID L BUCH MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 PINE ST SUITE 1A
PHILADELPHIA PA
19107-6187
US

IV. Provider business mailing address

822 PINE ST SUITE 1A
PHILADELPHIA PA
19107-6187
US

V. Phone/Fax

Practice location:
  • Phone: 215-629-0195
  • Fax: 215-629-0341
Mailing address:
  • Phone: 215-629-0195
  • Fax: 215-629-0341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberMD030827E
License Number StatePA

VIII. Authorized Official

Name: DR. DAVID L BUCH
Title or Position: PRESIDENT
Credential: MD
Phone: 215-629-0195