Provider Demographics
NPI:1740262971
Name:BUENDIA, ANTONIO (MD)
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:BUENDIA
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 1645
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26507-1645
Mailing Address - Country:US
Mailing Address - Phone:304-598-2291
Mailing Address - Fax:304-598-2293
Practice Address - Street 1:350 N 11TH ST
Practice Address - Street 2:
Practice Address - City:SUNBURY
Practice Address - State:PA
Practice Address - Zip Code:17801-1611
Practice Address - Country:US
Practice Address - Phone:570-286-3472
Practice Address - Fax:570-286-3397
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030587E2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009884480002Medicaid
PA0009884480007Medicaid
PA0009884480004Medicaid
PA4433688OtherBLUE SHIELD
PA0009884480002Medicaid
PA443368JAMMedicare PIN
PA4433688OtherBLUE SHIELD
PA443368W3RMedicare PIN