Provider Demographics
NPI:1952379745
Name:BUCKLEY, KRISTA K (DO)
Entity Type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:K
Last Name:BUCKLEY
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 1:71 OLD MILL BOTTOM RD N
Mailing Address - Street 2:STE 300
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21409-5410
Mailing Address - Country:US
Mailing Address - Phone:410-268-3887
Mailing Address - Fax:
Practice Address - Street 1:71 OLD MILL BOTTOM RD N
Practice Address - Street 2:STE 300
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21409-5410
Practice Address - Country:US
Practice Address - Phone:410-268-3887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0067007207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology