Provider Demographics
NPI:1518563790
Name:BUCKNER VEIN AND AESTHETICS LLC
Entity Type:Organization
Organization Name:BUCKNER VEIN AND AESTHETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCKNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-913-5900
Mailing Address - Street 1:1330 LIBERTY RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6412
Mailing Address - Country:US
Mailing Address - Phone:240-913-5900
Mailing Address - Fax:240-913-5901
Practice Address - Street 1:1330 LIBERTY RD
Practice Address - Street 2:SUITE H
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6412
Practice Address - Country:US
Practice Address - Phone:240-913-5900
Practice Address - Fax:240-913-5901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-11
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty