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General NPI Number Information
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NPI Number | 1407914989
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Entity Type | Individual
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Provider Name | MARY REBECCA BUCKLEY MHS, PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 01/31/2020
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Provider Practice Location Address
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Address Line | 6TH AVE AND SPRUCE ST, CENTER FOR MENTAL HEALTH THE READING HOSPITAL AND MEDICAL CENTER
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City | WEST READING
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State | PA
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Zip | 19611
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Country | US
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Telephone | 484-628-9870
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 16052
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City | READING
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State | PA
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Zip | 19612-6052
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Country | US
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Telephone |
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA001066L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA001066L
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License Number State | PA
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