Provider Demographics
NPI:1407254246
Name:BUCHHEIT, PAUL
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:BUCHHEIT
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 1:417 WEDGEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5534
Mailing Address - Country:US
Mailing Address - Phone:857-366-0796
Mailing Address - Fax:
Practice Address - Street 1:417 WEDGEWOOD LN
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5534
Practice Address - Country:US
Practice Address - Phone:857-366-0796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-10
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL3246171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator