Provider Demographics
NPI:1518548098
Name:BUCK, MATTHEW BRADFORD
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:BRADFORD
Last Name:BUCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 WALNUT ST STE 1100
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5001
Mailing Address - Country:US
Mailing Address - Phone:215-955-1416
Mailing Address - Fax:215-923-1884
Practice Address - Street 1:1025 WALNUT ST STE 1100
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5001
Practice Address - Country:US
Practice Address - Phone:215-955-1416
Practice Address - Fax:215-955-1416
Is Sole Proprietor?:No
Enumeration Date:2021-04-16
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program