Provider Demographics
NPI:1942380001
Name:BUCHLY, MARK LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:LEE
Last Name:BUCHLY
Suffix:
Gender:M
Credentials:MD
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 418498
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-8498
Mailing Address - Country:US
Mailing Address - Phone:703-558-1544
Mailing Address - Fax:
Practice Address - Street 1:106 IRVING ST NW
Practice Address - Street 2:SUITE 124-SOUTH
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2927
Practice Address - Country:US
Practice Address - Phone:202-877-3785
Practice Address - Fax:202-877-3740
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD0000-13451208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD15012-1600Medicaid
VA7306989Medicaid
DC0261065-00Medicaid
DC0261065-00Medicaid
VA7306989Medicaid