Provider Demographics
NPI:1528535663
Name:BUCKMAN, ADA MAE
Entity type:Individual
Prefix:
First Name:ADA
Middle Name:MAE
Last Name:BUCKMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-2872
Mailing Address - Country:US
Mailing Address - Phone:301-839-5725
Mailing Address - Fax:
Practice Address - Street 1:607 SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-2872
Practice Address - Country:US
Practice Address - Phone:301-839-5725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-26
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant