Provider Demographics
NPI:1215922075
Name:BUCKLEY, NANCY P (MD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:P
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 E ERIE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-1011
Mailing Address - Country:US
Mailing Address - Phone:215-427-3750
Mailing Address - Fax:
Practice Address - Street 1:6608 CASTOR AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-2120
Practice Address - Country:US
Practice Address - Phone:215-342-7710
Practice Address - Fax:215-918-5776
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042302E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1298594Medicaid
PA1298594Medicaid
F64551Medicare UPIN