Provider Demographics
NPI:1477511152
Name:DUGAN, BUCHANAN MERRYMAN (MD)
Entity Type:Individual
Prefix:
First Name:BUCHANAN
Middle Name:MERRYMAN
Last Name:DUGAN
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 1:725 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201
Mailing Address - Country:US
Mailing Address - Phone:413-447-2752
Mailing Address - Fax:413-496-6836
Practice Address - Street 1:911 GORMAN AVE
Practice Address - Street 2:STE 103
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241
Practice Address - Country:US
Practice Address - Phone:304-637-9302
Practice Address - Fax:304-637-9306
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226382208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2112540Medicaid
A39457Medicare ID - Type Unspecified
MA2112540Medicaid