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General NPI Number Information
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NPI Number | 1992132161
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Entity Type | Organization
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Legal Business Name | FAMILY MEDICINE PARTERSHIP
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Dates
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Enumeration Date | 10/03/2013
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Last Update Date | 10/03/2013
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Provider Practice Location Address
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Address Line | 921 BOSTON TPKE STE A
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City | BOLTON
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State | CT
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Zip | 06043-7403
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Country | US
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Telephone | 860-646-0649
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Fax | 860-649-1995
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Provider Business Mailing Address
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Address Line | 921 BOSTON TPKE STE A
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City | BOLTON
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State | CT
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Zip | 06043-7403
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Country | US
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Telephone | 860-646-0649
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Fax | 860-649-1995
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Authorized Official
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Title or Position | OWNER
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Name | DR. RONALD BUCKMAN
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Credential | MD
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Telephone | 860-646-0649
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 5515
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License Number State | CT
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