Provider Demographics
NPI:1386678647
Name:BUCKLEY, DONALD CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:CHARLES
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 1:4030 SMITH RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45209-1957
Mailing Address - Country:US
Mailing Address - Phone:513-421-3494
Mailing Address - Fax:513-345-2606
Practice Address - Street 1:4030 SMITH RD
Practice Address - Street 2:SUITE 300
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45209-1957
Practice Address - Country:US
Practice Address - Phone:513-421-3494
Practice Address - Fax:513-345-2606
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35050437B208600000X, 208G00000X
KY36934208600000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000064646OtherANTHEM
1800124OtherUNITED HEALTHCARE
50437OtherCHOICE CARE/HUMANA
IN100355170BMedicaid
310804060027OtherCARESOURCE
OH0782283Medicaid
KY64865868Medicaid
8330OtherKY BCBS
E54236Medicare UPIN
060056332Medicare PIN
000000064646OtherANTHEM
OH0665955Medicare ID - Type UnspecifiedOH MEDICARE
KY64865868Medicaid