Provider Demographics
NPI:1205456357
Name:BUCHAN, BRIAN (DED)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:BUCHAN
Suffix:
Gender:M
Credentials:DED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 STATE ST
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16127-1628
Mailing Address - Country:US
Mailing Address - Phone:724-992-2062
Mailing Address - Fax:
Practice Address - Street 1:315 STATE ST
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:PA
Practice Address - Zip Code:16127-1628
Practice Address - Country:US
Practice Address - Phone:724-992-2062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-19
Last Update Date:2020-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool