Provider Demographics
NPI:1073583456
Name:BIUCKIANS, GHADAM TOM (MD)
Entity Type:Individual
Prefix:DR
First Name:GHADAM
Middle Name:TOM
Last Name:BIUCKIANS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2014 WASHINGTON ST
Mailing Address - Street 2:GMOB STE 563
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02462
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:808 MAIN ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-8533
Practice Address - Country:US
Practice Address - Phone:781-893-5447
Practice Address - Fax:781-894-3037
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA39064208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2052474Medicaid
MABIB47162Medicare ID - Type Unspecified
MA2052474Medicaid