Provider Demographics
NPI:1417035643
Name:BUCHANAN, WILLIAM Y JR (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:Y
Last Name:BUCHANAN
Suffix:JR
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:PO BOX 468
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29116-0468
Mailing Address - Country:US
Mailing Address - Phone:803-534-0053
Mailing Address - Fax:803-536-1198
Practice Address - Street 1:1728 VILLAGE PARK DRIVE
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118
Practice Address - Country:US
Practice Address - Phone:803-534-0053
Practice Address - Fax:803-536-1198
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC55152085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC055157Medicaid
E94921Medicare UPIN
SC055157Medicaid