Provider Demographics
NPI:1558388090
Name:BUCKLEY, THOMAS M (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:BUCKLEY
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Gender:M
Credentials:MD
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Mailing Address - Street 1:789 HOWARD AVE # FMP305
Mailing Address - Street 2:PO BOX 208058
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1304
Mailing Address - Country:US
Mailing Address - Phone:203-785-5339
Mailing Address - Fax:203-785-4043
Practice Address - Street 1:330 ORCHARD ST
Practice Address - Street 2:SUITE 164
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4417
Practice Address - Country:US
Practice Address - Phone:203-785-2815
Practice Address - Fax:203-785-4043
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2015-12-27
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Provider Licenses
StateLicense IDTaxonomies
CT029419208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
340000262Medicare ID - Type Unspecified
F25881Medicare UPIN