Provider Demographics
NPI:1659690550
Name:BUCKWALTER, LENA JO (MD)
Entity Type:Individual
Prefix:DR
First Name:LENA
Middle Name:JO
Last Name:BUCKWALTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LENA
Other - Middle Name:JO
Other - Last Name:FRANKLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8820 S MERIDIAN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46217-6058
Mailing Address - Country:US
Mailing Address - Phone:317-865-6750
Mailing Address - Fax:317-865-6759
Practice Address - Street 1:8820 S MERIDIAN ST
Practice Address - Street 2:STE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46217-6058
Practice Address - Country:US
Practice Address - Phone:317-865-6750
Practice Address - Fax:317-865-6759
Is Sole Proprietor?:No
Enumeration Date:2010-05-18
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01073040A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201124770Medicaid
IN201124770Medicaid