Provider Demographics
NPI:1003887969
Name:BUCKNER, SCOTT C (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:C
Last Name:BUCKNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SCOTT
Other - Middle Name:CHARLES
Other - Last Name:BUCKNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1330 LIBERTY RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6412
Mailing Address - Country:US
Mailing Address - Phone:240-913-5900
Mailing Address - Fax:844-205-5691
Practice Address - Street 1:1330 LIBERTY RD
Practice Address - Street 2:SUITE H
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6412
Practice Address - Country:US
Practice Address - Phone:240-913-5900
Practice Address - Fax:240-913-5901
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD521792085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD937100100Medicaid
MDG03531Medicare UPIN
MDP00888647Medicare PIN
MD937100100Medicaid
MD937100100Medicaid