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NPI Code Detail

MEDICARE: DR. TIMOTHY J BUCKLEY DO

MEDICARE: DR. TIMOTHY J BUCKLEY DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician038815CT

General Provider Information

NPI Number : 1558372805
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TIMOTHY J BUCKLEY DO
Provider Business Mailing Address
First Line : 4 FARM SPRINGS RD
Second Line : PROHEALTH PHYSICIANS
City : FARMINGTON
State : CT
Zip : 06032-2573
Country : US
Telephone Number : 860-284-5200
Fax Number : 860-284-5333
Provider Business Practice Location Address
First Line : 415 KILLINGWORTH RD
Second Line :
City : HIGGANUM
State : CT
Zip : 06441-4370
Country : US
Telephone Number : 860-345-8535
Fax Number : 860-345-8678
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2006
Last Update Date : 07/08/2007

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