Provider Demographics
NPI:1265490445
Name:BUCKLEY, CAITRIONA ANN MARY (MD)
Entity Type:Individual
Prefix:
First Name:CAITRIONA
Middle Name:ANN MARY
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:550 UNIVERSITY BLVD # UH4903
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5149
Practice Address - Country:US
Practice Address - Phone:317-948-2894
Practice Address - Fax:317-944-4224
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036121892207RP1001X, 207RC0200X
IN01079171A207RC0200X
MDD0057184207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4748OtherMEDICARE RAILROAD PTAN (GROUP)
T01596OtherMEDICARE PTAN (INDIVIDUAL)
IL036121892Medicaid
206147OtherMEDICARE PTAN (GROUP)
MD61038502OtherCAREFIRST BCBS
P00924094OtherMEDICARE RAILROAD PTAN (INDIVIDUAL)
IL1617373OtherBCBS OF IL
DC19460024OtherCAREFIRST BCBS
IN300005991Medicaid
MD415096100Medicaid
DC034830200Medicaid
H36826Medicare UPIN
IL209308007Medicare PIN
P00924094OtherMEDICARE RAILROAD PTAN (INDIVIDUAL)
DC034830200Medicaid
MD810000795Medicare PIN