Provider Demographics
NPI:1275543043
Name:BUCKLEY, LOUIS V (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:V
Last Name:BUCKLEY
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 1:365 MONTAUK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-4700
Mailing Address - Country:US
Mailing Address - Phone:860-442-0711
Mailing Address - Fax:860-442-0073
Practice Address - Street 1:365 MONTAUK AVE
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4700
Practice Address - Country:US
Practice Address - Phone:860-442-0711
Practice Address - Fax:860-442-0073
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT020170207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
20170CT01OtherANTHEM BLUE CROSS
0012170CLOtherBLUE CARE FAMILY PLAN
75621OtherCONNECTICARE
30503OtherHEALTHNET
CT4041679Medicaid
CT4024972Medicaid
NLS127OtherOXFORD
0012170CLOtherBLUE CARE FAMILY PLAN