Provider Demographics
NPI:1174668768
Name:HARRY W BUCHANAN IV MD
Entity Type:Organization
Organization Name:HARRY W BUCHANAN IV MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:610-433-2021
Mailing Address - Street 1:400 N 17TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-5052
Mailing Address - Country:US
Mailing Address - Phone:610-433-2021
Mailing Address - Fax:610-433-7856
Practice Address - Street 1:400 N 17TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-5052
Practice Address - Country:US
Practice Address - Phone:610-433-2021
Practice Address - Fax:610-433-7856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102862302Medicaid
PA102862302Medicaid
PA0196140001Medicare NSC
PA077714Medicare ID - Type Unspecified