Provider Demographics
NPI:1720221120
Name:BUCKLEY, JONATHAN DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:DOUGLAS
Last Name:BUCKLEY
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 1:599 ARCOLA RD
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-3954
Mailing Address - Country:US
Mailing Address - Phone:484-565-8440
Mailing Address - Fax:
Practice Address - Street 1:599 ARCOLA RD
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-3954
Practice Address - Country:US
Practice Address - Phone:484-565-8440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD447233207P00000X, 207Q00000X
WV24638207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine