Provider Demographics
NPI:1477666857
Name:BUCHER, BRUCE MYRON (MD MPH SCD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:MYRON
Last Name:BUCHER
Suffix:
Gender:M
Credentials:MD MPH SCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 CHARLOTTE ST.
Mailing Address - Street 2:PO BOX 547
Mailing Address - City:TAPPAHANNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22560-0547
Mailing Address - Country:US
Mailing Address - Phone:804-443-5378
Mailing Address - Fax:804-443-9667
Practice Address - Street 1:721 CHARLOTTE ST.
Practice Address - Street 2:
Practice Address - City:TAPPAHANNOCK
Practice Address - State:VA
Practice Address - Zip Code:22560-0547
Practice Address - Country:US
Practice Address - Phone:804-443-5378
Practice Address - Fax:804-443-9667
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101032327207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006091237Medicaid
VAC06695OtherGROUP PTAN
VA012749OtherBCBS
VAC06695OtherGROUP PTAN
B10129Medicare UPIN