Provider Demographics
NPI:1831136092
Name:BUCZEWSKI, MARK A (DO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:BUCZEWSKI
Suffix:
Gender:M
Credentials:DO
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 13579
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19612-3579
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:321 N FURNACE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BIRDSBORO
Practice Address - State:PA
Practice Address - Zip Code:19508-2057
Practice Address - Country:US
Practice Address - Phone:610-898-9330
Practice Address - Fax:610-582-1464
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006217L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA007037315Medicaid
PA01145501OtherCAPITAL BLUE CROSS
PA607060OtherBLUE SHIELD
PA01145501OtherCAPITAL BLUE CROSS
PA007037315Medicaid