Healthcare Provider Details

I. General information

NPI: 1598760555
Provider Name (Legal Business Name): PAUL S BUCKMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 10/13/2020
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15210 L P BAILEY MEMORIAL HWY
NATHALIE VA
24577-3304
US

IV. Provider business mailing address

15210 L P BAILEY MEMORIAL HWY
NATHALIE VA
24577-3304
US

V. Phone/Fax

Practice location:
  • Phone: 434-349-3113
  • Fax: 434-349-2172
Mailing address:
  • Phone: 434-349-3113
  • Fax: 434-349-2172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101038108
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: