Provider Demographics
NPI:1891790358
Name:BUYER, DOUGLAS MICHAEL (PHD, LLC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:MICHAEL
Last Name:BUYER
Suffix:
Gender:M
Credentials:PHD, LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1438 W 38TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2324
Mailing Address - Country:US
Mailing Address - Phone:814-315-4054
Mailing Address - Fax:814-455-5656
Practice Address - Street 1:1438 W 38TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2324
Practice Address - Country:US
Practice Address - Phone:814-315-4054
Practice Address - Fax:814-281-3061
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006323L103TC2200X
PAPS-006323-L103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01486280Medicaid
PA1891790358OtherMEDICARE-NPI