Provider Demographics
NPI:1891788964
Name:BUCHANAN, LARRY D (DO)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:D
Last Name:BUCHANAN
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 714030
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45271-0001
Mailing Address - Country:US
Mailing Address - Phone:866-684-1484
Mailing Address - Fax:614-717-9845
Practice Address - Street 1:1 WYOMING ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2722
Practice Address - Country:US
Practice Address - Phone:937-208-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-5218B2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0844251Medicaid
OH00000504001OtherANTHEM
OH4200265Medicare ID - Type Unspecified
OH00000504001OtherANTHEM
OH4019018Medicare ID - Type Unspecified
B43577Medicare UPIN
OH4019019Medicare ID - Type Unspecified
OH4200263Medicare PIN
OHBU0702279Medicare ID - Type Unspecified
OH4200264Medicare ID - Type Unspecified
OH0844251Medicaid