Provider Demographics
NPI:1922473669
Name:BUCHANAN, AMANDA (MS)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 LANARK RD
Mailing Address - Street 2:APT 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-7239
Mailing Address - Country:US
Mailing Address - Phone:978-939-9248
Mailing Address - Fax:617-636-4430
Practice Address - Street 1:800 WASHINGTON ST
Practice Address - Street 2:811
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1552
Practice Address - Country:US
Practice Address - Phone:617-636-8174
Practice Address - Fax:617-636-4430
Is Sole Proprietor?:No
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAGC225170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS