Provider Demographics
NPI:1609808757
Name:BUCKY, LOUIS PHILIP (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:PHILIP
Last Name:BUCKY
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 1:200 W MONTGOMERY AVE
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-1416
Mailing Address - Country:US
Mailing Address - Phone:610-649-2433
Mailing Address - Fax:215-829-6327
Practice Address - Street 1:200 W MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003-1416
Practice Address - Country:US
Practice Address - Phone:610-649-2433
Practice Address - Fax:215-829-6327
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD056328L2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015400260004Medicaid
PA0015400260004Medicaid
E16258Medicare UPIN