Provider Demographics
NPI:1679698344
Name:BUCK, JAMES RUSSELL (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:RUSSELL
Last Name:BUCK
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:PO BOX 64563
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4563
Mailing Address - Country:US
Mailing Address - Phone:410-933-7440
Mailing Address - Fax:
Practice Address - Street 1:6565 N CHARLES ST
Practice Address - Street 2:STE 305
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-6800
Practice Address - Country:US
Practice Address - Phone:443-849-6201
Practice Address - Fax:443-849-6280
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00169542086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD10225716OtherAMERIGROUP
MDT409/0001OtherCAREFIRST REGIONAL
MD4140449OtherAETNA NON HMO
MD100521OtherKAISER
MD311731600Medicaid
MD51774OtherUHC/MAMSI
MDLN89CH/30516006OtherCAREFIRST OF MD
MD2230415OtherAETNA HMO
MD100521OtherKAISER
MDLN89CH/30516006OtherCAREFIRST OF MD