Provider Demographics
NPI:1235109992
Name:BUCKWALTER, VICTOR L (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:L
Last Name:BUCKWALTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1151 KEEZLETOWN RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WEYERS CAVE
Mailing Address - State:VA
Mailing Address - Zip Code:24486-0189
Mailing Address - Country:US
Mailing Address - Phone:540-234-9241
Mailing Address - Fax:540-234-9200
Practice Address - Street 1:1151 KEEZLETOWN RD
Practice Address - Street 2:SUITE 101
Practice Address - City:WEYERS CAVE
Practice Address - State:VA
Practice Address - Zip Code:24486-0189
Practice Address - Country:US
Practice Address - Phone:540-234-9241
Practice Address - Fax:540-234-9200
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-040006207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1235109992Medicaid
VA005623090Medicaid
VAVV5377BOtherMEDICARE PTAN
F58422Medicare UPIN
VAVV5377BOtherMEDICARE PTAN
080005631Medicare ID - Type Unspecified
VA1235109992Medicaid