Provider Demographics
NPI:1083710735
Name:WOO, BUCK (PHD)
Entity Type:Individual
Prefix:
First Name:BUCK
Middle Name:
Last Name:WOO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:715 ALBANY ST
Mailing Address - Street 2:F BLDG, REHAB MED
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2526
Mailing Address - Country:US
Mailing Address - Phone:617-414-2000
Mailing Address - Fax:617-414-1975
Practice Address - Street 1:715 ALBANY ST
Practice Address - Street 2:F BLDG, REHAB MED
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2526
Practice Address - Country:US
Practice Address - Phone:617-414-2000
Practice Address - Fax:617-414-1975
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MAMA4951103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist