Provider Demographics
NPI:1780802884
Name:BUENO, ELEANOR A (DO)
Entity type:Individual
Prefix:
First Name:ELEANOR
Middle Name:A
Last Name:BUENO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-4054
Mailing Address - Country:US
Mailing Address - Phone:888-897-1887
Mailing Address - Fax:857-343-8192
Practice Address - Street 1:101 WALNUT ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-4054
Practice Address - Country:US
Practice Address - Phone:888-897-1887
Practice Address - Fax:857-343-8192
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH14057207Q00000X
MA258578207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine