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General NPI Number Information
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NPI Number | 1043320815
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Entity Type | Individual
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Provider Name | YETUNDE BUCKNOR MD
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Gender | Female
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 220 GIRARD ST STE 100
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City | GAITHERSBURG
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State | MD
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Zip | 20877-3467
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Country | US
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Telephone | 301-216-0880
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Fax | 301-216-2891
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Provider Business Mailing Address
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Address Line | 8665 GEORGIA AVE
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City | SILVER SPRING
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State | MD
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Zip | 20910-3405
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Country | US
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Telephone | 301-340-7525
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Fax | 301-495-0318
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | D0075721
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License Number State | MD
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