Healthcare Provider Details

I. General information

NPI: 1114287117
Provider Name (Legal Business Name): ASHESH N. BUCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2012
Last Update Date: 03/19/2021
Certification Date: 03/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MEDICAL PKWY FL 2
CHESAPEAKE VA
23320-0302
US

IV. Provider business mailing address

PO BOX 11314
BELFAST ME
04915-4004
US

V. Phone/Fax

Practice location:
  • Phone: 757-312-4047
  • Fax: 757-410-0339
Mailing address:
  • Phone: 757-842-4481
  • Fax: 757-312-3135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number2012-00609
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number0101270728
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: