Provider Demographics
NPI:1649233727
Name:BUCHANAN, ROBERT W (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:W
Last Name:BUCHANAN
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 1:300 CONCERT WAY
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-5567
Mailing Address - Country:US
Mailing Address - Phone:410-719-0073
Mailing Address - Fax:
Practice Address - Street 1:SPRING GROVE HOSPITAL GROUNDS
Practice Address - Street 2:MAPLE AND LOCUST STREETS
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228
Practice Address - Country:US
Practice Address - Phone:410-402-7876
Practice Address - Fax:410-402-7198
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00308072084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD462321500Medicaid
MDF24317Medicare UPIN