Provider Demographics
NPI:1386733244
Name:BUCKLEY, MARTHA L (MD)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:L
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 1:805 MOUNT ZION RD SW
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-9542
Mailing Address - Country:US
Mailing Address - Phone:740-243-5859
Mailing Address - Fax:
Practice Address - Street 1:1550 SHERIDAN DR
Practice Address - Street 2:SUITE 202
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-1381
Practice Address - Country:US
Practice Address - Phone:740-654-0232
Practice Address - Fax:740-654-9794
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301078318207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4765638Medicaid
MII39054Medicare UPIN
MI0H17613766Medicare ID - Type Unspecified