Provider Demographics
NPI:1841233525
Name:BUCKWALTER, PHYLLIS S (MD)
Entity Type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:S
Last Name:BUCKWALTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:WELSH ROAD AT INVERNESS DRIVE
Mailing Address - Street 2:
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044
Mailing Address - Country:US
Mailing Address - Phone:215-659-1113
Mailing Address - Fax:215-659-0296
Practice Address - Street 1:WELSH ROAD AT INVERNESS DRIVE
Practice Address - Street 2:
Practice Address - City:HORSHAM
Practice Address - State:PA
Practice Address - Zip Code:19044
Practice Address - Country:US
Practice Address - Phone:215-659-1113
Practice Address - Fax:215-659-0296
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD25524L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB33924Medicare ID - Type Unspecified
PAB032836Medicare UPIN