Provider Demographics
NPI:1467448555
Name:BUCKLEY, RONALD J (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:J
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 1:421 W CHEW ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-3406
Mailing Address - Country:US
Mailing Address - Phone:610-776-5315
Mailing Address - Fax:610-663-3113
Practice Address - Street 1:1210 HANOVER AVE
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18109-2017
Practice Address - Country:US
Practice Address - Phone:610-437-6490
Practice Address - Fax:610-437-4151
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD020876E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
01397201OtherCBC
020766OtherHIGHMARK BLUE SHIELD
0040768000OtherIBC
P003146OtherGATEWAY
PA0017586300001Medicaid
1129063OtherAMERIHEALTH MERCY HEALTH
PA010057336Medicare PIN
0040768000OtherIBC
PAC27703Medicare UPIN