Provider Demographics
NPI:1407896012
Name:BUCHANAN, CONNIE D (MD)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:D
Last Name:BUCHANAN
Suffix:
Gender:F
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:PO BOX 55310
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5310
Mailing Address - Country:US
Mailing Address - Phone:205-731-9701
Mailing Address - Fax:
Practice Address - Street 1:619 19TH STREET SOUTH
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233
Practice Address - Country:US
Practice Address - Phone:205-934-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL043432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51599726OtherBLUE CROSS
AL51599338OtherBLUE CROSS
AL000016011OtherBLUE CROSS
AL000016011Medicaid
AL51599340OtherBLUE CROSS
AL051502088OtherBC FEDERAL EHBP
AL330500058OtherMEDICAID REHAB
AL51599339OtherBLUE CROSS
AL260017800OtherRAILROAD MEDICARE
ALC79003OtherVIVA
ALC79003OtherVIVA