Provider Demographics
NPI:1598760555
Name:BUCKMAN, PAUL S (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:S
Last Name:BUCKMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15210 L P BAILEY MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:NATHALIE
Mailing Address - State:VA
Mailing Address - Zip Code:24577-3304
Mailing Address - Country:US
Mailing Address - Phone:434-349-3113
Mailing Address - Fax:434-349-2172
Practice Address - Street 1:15210 L P BAILEY MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:NATHALIE
Practice Address - State:VA
Practice Address - Zip Code:24577-3304
Practice Address - Country:US
Practice Address - Phone:434-349-3113
Practice Address - Fax:434-349-2172
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101038108207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007610661Medicaid
VAB07985Medicare UPIN
VA1598760555Medicare PIN