Provider Demographics
NPI:1932298098
Name:BUCKLEY, LENORE M (MD)
Entity Type:Individual
Prefix:DR
First Name:LENORE
Middle Name:M
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:300 CEDAR ST
Mailing Address - Street 2:TAC S517
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1612
Mailing Address - Country:US
Mailing Address - Phone:203-737-5430
Mailing Address - Fax:203-785-7053
Practice Address - Street 1:800 HOWARD ST.
Practice Address - Street 2:YPB 3RD FLOOR
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1612
Practice Address - Country:US
Practice Address - Phone:203-737-5430
Practice Address - Fax:203-785-7053
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2012-06-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101049859207RR0500X
CT050826207RR0500X, 2080P0216X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No2080P0216XAllopathic & Osteopathic PhysiciansPediatricsPediatric Rheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006003893 541581185Medicaid
VA006003893 541581185Medicaid
370000896 C03684Medicare ID - Type Unspecified