Provider Demographics
NPI:1982623146
Name:BUCH, DEEPAK D (MD)
Entity Type:Individual
Prefix:DR
First Name:DEEPAK
Middle Name:D
Last Name:BUCH
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 1:175 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13365-1300
Mailing Address - Country:US
Mailing Address - Phone:315-823-0351
Mailing Address - Fax:531-582-3188
Practice Address - Street 1:175 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:NY
Practice Address - Zip Code:13365-1300
Practice Address - Country:US
Practice Address - Phone:315-823-0351
Practice Address - Fax:531-582-3188
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166837207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00994830Medicaid
NY56913BMedicare ID - Type Unspecified
NYB82900Medicare UPIN