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General NPI Number Information
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NPI Number | 1134128051
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Entity Type | Individual
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Provider Name | CHARLES EDWARD BUCKLEY MD
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Gender | Male
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Dates
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Enumeration Date | 07/21/2005
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Last Update Date | 03/14/2008
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Provider Practice Location Address
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Address Line | 4700 BERWYN HOUSE RD SUITE 102
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City | COLLEGE PARK
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State | MD
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Zip | 20740-2474
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Country | US
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Telephone | 301-345-0406
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Fax | 301-345-0409
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Provider Business Mailing Address
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Address Line | 4700 BERWYN HOUSE RD SUITE 207
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City | COLLEGE PARK
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State | MD
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Zip | 20740-2474
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Country | US
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Telephone | 301-220-0150
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Fax | 301-220-1032
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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 | 2085N0904X
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Taxonomy Name | Nuclear Radiology Physician
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License Number | D16341
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 2085N0904X
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Taxonomy Name | Nuclear Radiology Physician
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License Number | MD25540
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 2085N0904X
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Taxonomy Name | Nuclear Radiology Physician
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License Number | 019671
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License Number State | VA
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