Provider Demographics
NPI:1083863187
Name:BUCKNELL UNIVERSITY
Entity Type:Organization
Organization Name:BUCKNELL UNIVERSITY
Other - Org Name:STUDENT HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:W
Authorized Official - Last Name:STECHSCHULTE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:570-577-1401
Mailing Address - Street 1:701 MOORE AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-2010
Mailing Address - Country:US
Mailing Address - Phone:570-577-1401
Mailing Address - Fax:
Practice Address - Street 1:701 MOORE AVE
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-2010
Practice Address - Country:US
Practice Address - Phone:570-577-1401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP000171F261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health