Provider Demographics
NPI:1477740322
Name:G. TOM BIUCKIANS, MD PC
Entity Type:Organization
Organization Name:G. TOM BIUCKIANS, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:G.
Authorized Official - Middle Name:TOM
Authorized Official - Last Name:BIUCKIANS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-965-9611
Mailing Address - Street 1:2000 WASHINGTON ST
Mailing Address - Street 2:SUITE 224
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02462-1650
Mailing Address - Country:US
Mailing Address - Phone:617-965-9611
Mailing Address - Fax:617-965-0400
Practice Address - Street 1:2000 WASHINGTON ST
Practice Address - Street 2:SUITE 224
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462-1650
Practice Address - Country:US
Practice Address - Phone:617-965-9611
Practice Address - Fax:617-965-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA039064208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB47162OtherBLUE CROSS BLUE SHIELD
MAB47162OtherBLUE CROSS BLUE SHIELD