Provider Demographics
NPI:1386813871
Name:DRS. RICHARD & PHYLLIS BUCKWALTER
Entity Type:Organization
Organization Name:DRS. RICHARD & PHYLLIS BUCKWALTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCKWALTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-659-1113
Mailing Address - Street 1:WELSH ROAD AT INVERNESS DRIVE
Mailing Address - Street 2:
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-1801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:WELSH ROAD AT INVERNESS DRIVE
Practice Address - Street 2:
Practice Address - City:HORSHAM
Practice Address - State:PA
Practice Address - Zip Code:19044-1801
Practice Address - Country:US
Practice Address - Phone:215-659-1113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD25525L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty