Provider Demographics
NPI:1376076927
Name:BUCHWALDER, MAXWELL JOSEPH
Entity Type:Individual
Prefix:
First Name:MAXWELL
Middle Name:JOSEPH
Last Name:BUCHWALDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 CHERRY ST, ACC BLDG 1ST FLOOR
Mailing Address - Street 2:MERCY ST VINCENT MEDICAL CENTER, EM RESIDENCY PROGRAM
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43608
Mailing Address - Country:US
Mailing Address - Phone:419-251-4724
Mailing Address - Fax:
Practice Address - Street 1:2213 CHERRY ST, ACC BLDG 1ST FLOOR
Practice Address - Street 2:MERCY ST VINCENT MEDICAL CENTER, EM RESIDENCY PROGRAM
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608
Practice Address - Country:US
Practice Address - Phone:419-251-4724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2020-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.014223207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine