MEDICARE: BUCKLAND EAR NOSE & THROAT LLC

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
1	235500000X	Speech/Language/Hearing Specialist/Technologist	000196	CT
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	174400000X	Specialist	021430	CT

General Provider Information

NPI Number	:	1881884641
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUCKLAND EAR NOSE & THROAT LLC

Provider Business Mailing Address
First Line	:	360 TOLLAND TPKE
Second Line	:	SUITE 1E
City	:	MANCHESTER
State	:	CT
Zip	:	06042-1771
Country	:	US
Telephone Number	:	860-645-6675
Fax Number	:	860-645-8677

Provider Business Practice Location Address
First Line	:	360 TOLLAND TPKE
Second Line	:	SUITER 1E
City	:	MANCHESTER
State	:	CT
Zip	:	06042-1771
Country	:	US
Telephone Number	:	860-645-6675
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. BETSY GRAVES
Credential	:
Telephone Number	:	860-645-6675

Provider Enumeration Date	:	07/27/2007
Last Update Date	:	12/29/2015

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Directions to “BUCKLAND EAR NOSE & THROAT LLC ” Practice Location

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