Provider Demographics
NPI:1255493748
Name:VANBUSKIRK, ERIC VICTOR (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:VICTOR
Last Name:VANBUSKIRK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 FREDERICK ROAD
Mailing Address - Street 2:SUITE 251
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228
Mailing Address - Country:US
Mailing Address - Phone:410-788-3019
Mailing Address - Fax:410-788-3067
Practice Address - Street 1:405 FREDERICK ROAD
Practice Address - Street 2:SUITE 251
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228
Practice Address - Country:US
Practice Address - Phone:410-788-3019
Practice Address - Fax:410-788-3067
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00252752084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
D78186Medicare UPIN
492AMedicare ID - Type Unspecified