Provider Demographics
NPI:1093397747
Name:MADISON BUCHANAN MD
Entity Type:Organization
Organization Name:MADISON BUCHANAN MD
Other - Org Name:MADISON BUCHANAN MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:MADISON
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-494-9165
Mailing Address - Street 1:45 SAN CLEMENTE DR STE A200
Mailing Address - Street 2:
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1204
Mailing Address - Country:US
Mailing Address - Phone:415-494-9165
Mailing Address - Fax:
Practice Address - Street 1:240 TAMAL VISTA BLVD STE 160
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1156
Practice Address - Country:US
Practice Address - Phone:415-494-9165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-22
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health