Provider Demographics
NPI:1922110287
Name:BUECHLER, MARY (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:BUECHLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:BUECHLER
Other - Last Name:JANSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:36 ELM ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01833-2516
Mailing Address - Country:US
Mailing Address - Phone:978-352-2126
Mailing Address - Fax:
Practice Address - Street 1:170 GOVERNORS AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-1643
Practice Address - Country:US
Practice Address - Phone:781-306-6300
Practice Address - Fax:781-306-6312
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA36625207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0134210Medicaid
MA0134210Medicaid
MAA38736Medicare UPIN