Basic Information
Provider Information | |||||||||
NPI: | 1508251216 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BUCHANAN | ||||||||
FirstName: | RICA | ||||||||
MiddleName: | MAURICIO | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 9500 EUCLID AVE # NA23 | ||||||||
Address2: |   | ||||||||
City: | CLEVELAND | ||||||||
State: | OH | ||||||||
PostalCode: | 441950001 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8324444675 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 3300 GALLOWS RD | ||||||||
Address2: |   | ||||||||
City: | FALLS CHURCH | ||||||||
State: | VA | ||||||||
PostalCode: | 220423307 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7037764001 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/31/2015 | ||||||||
LastUpdateDate: | 05/14/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 05/14/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 125067288 | IL | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207L00000X | 0101274067 | VA | Y |   | Allopathic & Osteopathic Physicians | Anesthesiology |   | 207L00000X | 57.247099 | OH | N |   | Allopathic & Osteopathic Physicians | Anesthesiology |   |
No ID Information.