Provider Demographics
NPI:1518155233
Name:DAVID L BUCH MD PC
Entity Type:Organization
Organization Name:DAVID L BUCH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:BUCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-629-0195
Mailing Address - Street 1:822 PINE ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-6187
Mailing Address - Country:US
Mailing Address - Phone:215-629-0195
Mailing Address - Fax:215-629-0341
Practice Address - Street 1:822 PINE ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-6187
Practice Address - Country:US
Practice Address - Phone:215-629-0195
Practice Address - Fax:215-629-0341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030827E103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00865Medicare PIN