Provider Demographics
NPI:1588678585
Name:TAMY B. BUCKEL, M.D., P.A.
Entity Type:Organization
Organization Name:TAMY B. BUCKEL, M.D., P.A.
Other - Org Name:SHORE DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMY
Authorized Official - Middle Name:B
Authorized Official - Last Name:BUCKEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-778-0003
Mailing Address - Street 1:250 HAACKE DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620-3322
Mailing Address - Country:US
Mailing Address - Phone:410-778-0003
Mailing Address - Fax:
Practice Address - Street 1:250 HAACKE DR
Practice Address - Street 2:
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620-1193
Practice Address - Country:US
Practice Address - Phone:410-778-0003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0064239207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1467406553OtherMY INDIVIDUAL NPI #