Provider Demographics
NPI:1952365652
Name:BUCHBAUM, ERIC JASON (DPM)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:JASON
Last Name:BUCHBAUM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-3103
Mailing Address - Country:US
Mailing Address - Phone:401-789-1422
Mailing Address - Fax:401-782-6810
Practice Address - Street 1:1 HIGH ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-3103
Practice Address - Country:US
Practice Address - Phone:401-789-1422
Practice Address - Fax:401-782-6810
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDPM00302213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000021254OtherGENERIC4
RI11092609OtherCAQH#
407225OtherBLUE CHIP GROUP #
RISSN#-TAX ID# 2049285OtherRAILROAD MEDICARE
ZDZ388OtherMED EX
2382382OtherGENERIC3
RI4024OtherNEIGHBORHOOD HEALTH RI
5095486002OtherCIGNA
RIAETNA COM 7342159OtherAETNA HMO 1359024
RIPT SSN#OtherTRI CARE
PR204928511OtherUNITED HEALTH CARE
RI0000031650OtherBCBS
3916940001OtherGENERIC6
RI407225OtherBLUE CHIP
432037955OtherMED EX GROUP #
480034977OtherGENERIC7
RI7009003Medicaid
RIAA69503OtherHARVARD PILGRIM
RIPT SSN#OtherTRI CARE
RI0000031650OtherBCBS