Provider Demographics
NPI:1538110135
Name:BUCKMAN, PETER DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:DANIEL
Last Name:BUCKMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 HEALTH CAMPUS DRIVE
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801
Mailing Address - Country:US
Mailing Address - Phone:540-689-2110
Mailing Address - Fax:540-689-1910
Practice Address - Street 1:2010 HEALTH CAMPUS DRIVE
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801
Practice Address - Country:US
Practice Address - Phone:540-689-2110
Practice Address - Fax:540-689-1910
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052545174400000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1538110135Medicaid
P00614138Medicare PIN
VA00X710H01Medicare PIN
VAE68622Medicare UPIN
VA1538110135Medicare NSC
VA007400683Medicaid