Basic Information
| Provider Information | |||||||||
| NPI: | 1275671059 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DR.ANDREA S.BUCK PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 103 OLD MARLTON PIKE STE 215 | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080558772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6097140202 | ||||||||
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| Practice Location | |||||||||
| Address1: | 103 OLD MARLTON PIKE STE 215 | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080558772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6097140202 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2007 | ||||||||
| LastUpdateDate: | 12/13/2011 | ||||||||
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| AuthorizedOfficialLastName: | BUCK | ||||||||
| AuthorizedOfficialFirstName: | ANDREA | ||||||||
| AuthorizedOfficialMiddleName: | SUE | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 6097140202 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.