Provider Demographics
NPI:1093009995
Name:BUCKWALTER, NICHOLAS A (MD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:A
Last Name:BUCKWALTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-721-4860
Mailing Address - Fax:717-664-5028
Practice Address - Street 1:107 W END DR
Practice Address - Street 2:
Practice Address - City:MANHEIM
Practice Address - State:PA
Practice Address - Zip Code:17545-9320
Practice Address - Country:US
Practice Address - Phone:717-721-4860
Practice Address - Fax:717-664-5028
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD450204207Q00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA365717FLTMedicare PIN
PA365717UFWMedicare PIN