Provider Demographics
NPI:1326042961
Name:BUCKLAND, DAVID NELSON (PA-C)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:NELSON
Last Name:BUCKLAND
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 843145
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-3145
Mailing Address - Country:US
Mailing Address - Phone:910-428-1544
Mailing Address - Fax:910-428-1567
Practice Address - Street 1:104 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:BISCOE
Practice Address - State:NC
Practice Address - Zip Code:27209-9835
Practice Address - Country:US
Practice Address - Phone:910-428-1544
Practice Address - Fax:910-428-1567
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101879363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC170GFOtherBCBSNC
NC8102541Medicaid
NC170GFOtherBCBSNC
NC8102541Medicaid