=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871761379
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HARRY W BUCHANAN IV MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2008
-----------------------------------------------------
Last Update Date | 09/03/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 N 17TH ST
-----------------------------------------------------
City | ALLENTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18104-5052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-433-2021
-----------------------------------------------------
Fax | 610-433-7856
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 N 17TH ST
-----------------------------------------------------
City | ALLENTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18104-5052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-433-2021
-----------------------------------------------------
Fax | 610-433-7856
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. HARRY W BUCHANAN IV
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 610-433-2021
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | MD029484E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------