Basic Information
| Provider Information | |||||||||
| NPI: | 1447301700 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUCK | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | SUE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 103 OLD MARLTON PIKE | ||||||||
| Address2: | SUITE 215 MEDFORD MEDICAL BUILDING | ||||||||
| City: | MEDFORD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080558772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6097140202 | ||||||||
| FaxNumber: | 6097140303 | ||||||||
| Practice Location | |||||||||
| Address1: | 103 OLD MARLTON PIKE | ||||||||
| Address2: | SUITE 215 | ||||||||
| City: | MEDFORD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080558772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6097140202 | ||||||||
| FaxNumber: | 6097140303 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | MB52139 | NJ | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.