Provider Demographics
NPI:1932253317
Name:BUCKLEY, PAUL (MD, PHD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:BUCKLEY
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 THIRD HILL DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON SPRINGS
Mailing Address - State:ME
Mailing Address - Zip Code:04981-4148
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:360 BROADWAY
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3979
Practice Address - Country:US
Practice Address - Phone:207-262-1703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME016043207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8300003Medicaid
H203080Medicare UPIN
MEBU MM9870Medicare ID - Type Unspecified
NJ039667Medicare ID - Type Unspecified