Provider Demographics
NPI:1386356798
Name:BUCKLEY, CRAIG DAVID
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:DAVID
Last Name:BUCKLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9832 JOHNNYCAKE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-6712
Mailing Address - Country:US
Mailing Address - Phone:216-287-0937
Mailing Address - Fax:
Practice Address - Street 1:35000 KAISER CT
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-3382
Practice Address - Country:US
Practice Address - Phone:440-269-4600
Practice Address - Fax:216-229-6017
Is Sole Proprietor?:No
Enumeration Date:2022-12-16
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN319506163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care