Provider Demographics
NPI:1851489603
Name:BUCHWALDER, MARY PELSZYNSKI (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:PELSZYNSKI
Last Name:BUCHWALDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1781 SUNNYMEADE RD
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-9312
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 COLLEGE PARK AVE
Practice Address - Street 2:GOSIGER HEALTH CENTER 0900
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45469-0001
Practice Address - Country:US
Practice Address - Phone:937-229-3131
Practice Address - Fax:937-229-3107
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-5518207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F14837Medicare UPIN
BU0642861Medicare ID - Type Unspecified