Provider Demographics
NPI:1720019532
Name:BUCK, WARREN GREGORY (MD)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:GREGORY
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 1:111 JAMES STREET
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3967
Mailing Address - Country:US
Mailing Address - Phone:732-549-2299
Mailing Address - Fax:732-549-2262
Practice Address - Street 1:111 JAMES STREET
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3967
Practice Address - Country:US
Practice Address - Phone:732-549-2299
Practice Address - Fax:732-549-2262
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA0316500207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0485802Medicaid
429988AQTMedicare ID - Type Unspecified
D90464Medicare UPIN