Healthcare Provider Details

I. General information

NPI: 1902801947
Provider Name (Legal Business Name): VINCENT J BUCHINSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 01/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8691 STONEWALL RD
MANASSAS VA
20110-4510
US

IV. Provider business mailing address

8691 STONEWALL RD
MANASSAS VA
20110-4510
US

V. Phone/Fax

Practice location:
  • Phone: 703-368-1182
  • Fax: 703-257-6711
Mailing address:
  • Phone: 703-368-1182
  • Fax: 703-257-6711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101034986
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: