Provider Demographics
NPI:1619941986
Name:BUCHNESS, MICHAEL P (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:BUCHNESS
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 1:4404 COOPER ROAD
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:MD
Mailing Address - Zip Code:21822-2149
Mailing Address - Country:US
Mailing Address - Phone:410-453-4000
Mailing Address - Fax:410-543-4151
Practice Address - Street 1:351 DEER'S HEAD HOSPITAL ROAD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-3201
Practice Address - Country:US
Practice Address - Phone:410-543-4000
Practice Address - Fax:410-543-4151
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD020382086S0129X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD201061500Medicaid
CC75Medicare ID - Type Unspecified
MD201061500Medicaid