Provider Demographics
NPI:1174511349
Name:BUCKLEY, CARIE DANIEL III (MD)
Entity Type:Individual
Prefix:
First Name:CARIE
Middle Name:DANIEL
Last Name:BUCKLEY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CARIE
Other - Middle Name:D
Other - Last Name:BUCKLEY
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:70 MEDICAL CENTER CIR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-2273
Mailing Address - Country:US
Mailing Address - Phone:540-332-5926
Mailing Address - Fax:540-332-5930
Practice Address - Street 1:70 MEDICAL CENTER CIR
Practice Address - Street 2:SUITE 208
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2273
Practice Address - Country:US
Practice Address - Phone:540-332-5926
Practice Address - Fax:540-332-5930
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101033256208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA011346OtherBCBS ANTHEM
B05887Medicare UPIN