Provider Demographics
NPI:1407838402
Name:BUKI, KATHERINE S (MD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:S
Last Name:BUKI
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 1:300 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4541
Mailing Address - Country:US
Mailing Address - Phone:301-662-8119
Mailing Address - Fax:301-696-0985
Practice Address - Street 1:1562 OPOSSUMTOWN PIKE
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4337
Practice Address - Country:US
Practice Address - Phone:301-662-8119
Practice Address - Fax:301-696-0985
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD54705174400000X
MDD0054705207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1407838402OtherMEDICAID NPI
MD290012174OtherMEDICARE RAILROAD
MD283003500Medicaid
MD290012174OtherMEDICARE RAILROAD
MD283003500Medicaid