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General NPI Number Information
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NPI Number | 1578549010
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Entity Type | Individual
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Provider Name | MIRIAM S. BUCKBERG MD
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Gender | Female
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Dates
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Enumeration Date | 12/16/2005
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Last Update Date | 01/31/2020
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Provider Practice Location Address
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Address Line | 701 ENFIELD STREET
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City | ENFIELD
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State | CT
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Zip | 06082
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Country | US
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Telephone | 860-741-6058
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Fax | 860-253-9326
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Provider Business Mailing Address
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Address Line | 2150 MAIN STREET
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City | SPRINGFIELD
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State | MA
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Zip | 01104
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Country | US
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Telephone | 413-739-5676
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Fax | 413-733-5860
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35070556
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 017423
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License Number State | ME
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 64731
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 251720
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License Number State | MA
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