Provider Demographics
NPI:1164463329
Name:BUCHNER, BRUCE
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:BUCHNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:462 GRIDER ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-3021
Mailing Address - Country:US
Mailing Address - Phone:716-898-3424
Mailing Address - Fax:
Practice Address - Street 1:462 GRIDER ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3021
Practice Address - Country:US
Practice Address - Phone:716-898-3424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY15996412085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01256968Medicaid
00040148307OtherUNIVERA
140849FFOtherPREFERRED CARE
P00384940OtherRAILROAD MEDICARE
NYR1599646OtherWORKERS COMPENSATION
000402906012OtherBLUE SHIELD OF WESTERN NY
P00375057OtherRAILROAD MEDICARE
000402906013OtherBLUE SHIELD OF WESTERN NY
1611324OtherINDEPENDANT HEALTH
00040148308OtherUNIVERA
P00384940OtherRAILROAD MEDICARE
00040148307OtherUNIVERA
000402906012OtherBLUE SHIELD OF WESTERN NY
1611324OtherINDEPENDANT HEALTH