Provider Demographics
NPI:1306995725
Name:FAMILY MEDICINE PARTNERSHIP, PC
Entity type:Organization
Organization Name:FAMILY MEDICINE PARTNERSHIP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:BUCKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-646-0649
Mailing Address - Street 1:921 BOSTON TURNPIKE
Mailing Address - Street 2:P O. BOX 9547
Mailing Address - City:BOLTON
Mailing Address - State:CT
Mailing Address - Zip Code:06043
Mailing Address - Country:US
Mailing Address - Phone:860-646-0649
Mailing Address - Fax:860-649-9195
Practice Address - Street 1:921 BOSTON TURNPIKE
Practice Address - Street 2:
Practice Address - City:BOLTON
Practice Address - State:CT
Practice Address - Zip Code:06043
Practice Address - Country:US
Practice Address - Phone:860-646-0649
Practice Address - Fax:860-649-9195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004199825Medicaid
CTC01594Medicare ID - Type Unspecified