Provider Demographics
NPI:1689627648
Name:PENN NEUROLOGIC ASSOCIATES
Entity Type:Organization
Organization Name:PENN NEUROLOGIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BUCKLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-257-4900
Mailing Address - Street 1:920 LAWN AVE
Mailing Address - Street 2:THE SUMMIT
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-1560
Mailing Address - Country:US
Mailing Address - Phone:215-257-4900
Mailing Address - Fax:215-257-6681
Practice Address - Street 1:920 LAWN AVE
Practice Address - Street 2:THE SUMMIT
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1560
Practice Address - Country:US
Practice Address - Phone:215-257-4900
Practice Address - Fax:215-257-6681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040916E2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA03195000OtherCAPITAL BLUE CROSS
PA0085270OtherCIGNA
PA1001358OtherKEYSTONE MERCY
PA5740334OtherAETNA COMERCIAL
PA0055941OtherUS HEALTHCARE
PA0012941560002Medicaid
PA0022227000OtherKEYSTONE HEALTH PLAN EAST
PA0022227000OtherKEYSTONE HEALTH PLAN EAST