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General NPI Number Information
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NPI Number | 1598862799
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Entity Type | Individual
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Provider Name | CHESTER CHURCH BUCKENMAIER III M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | WALTER REED ARMY MEDICAL CTR
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City | WASHINGTON
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State | DC
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Zip | 20307-0001
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Country | US
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Telephone | 202-782-2949
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Fax | 202-782-5066
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Provider Business Mailing Address
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Address Line | 2420 POWDERHORN WAY
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City | GAMBRILLS
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State | MD
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Zip | 21054-1672
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Country | US
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Telephone | 410-721-1892
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Fax | 410-782-5066
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 9300661
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License Number State | NC
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