Provider Demographics
NPI:1942738679
Name:BUCKLEY, NICHOLAS SALPETER (DO)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:SALPETER
Last Name:BUCKLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 BOVET RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-3126
Mailing Address - Country:US
Mailing Address - Phone:650-554-1000
Mailing Address - Fax:650-554-1018
Practice Address - Street 1:66 BOVET RD STE 100
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-3126
Practice Address - Country:US
Practice Address - Phone:650-554-1000
Practice Address - Fax:650-554-1018
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A18014207QH0002X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine