Provider Demographics
NPI:1760724835
Name:BUCK, LOREN ASHLEY (DO)
Entity Type:Individual
Prefix:
First Name:LOREN
Middle Name:ASHLEY
Last Name:BUCK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:P O B OX 63308
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28263-3308
Mailing Address - Country:US
Mailing Address - Phone:866-264-3435
Mailing Address - Fax:864-987-1611
Practice Address - Street 1:222 HERLONG AVE S
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1158
Practice Address - Country:US
Practice Address - Phone:803-329-1234
Practice Address - Fax:864-987-1611
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2018-001182085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology