Basic Information
| Provider Information | |||||||||
| NPI: | 1407838402 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUKI | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 W 9TH ST | ||||||||
| Address2: | |||||||||
| City: | FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217014541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016628119 | ||||||||
| FaxNumber: | 3016960985 | ||||||||
| Practice Location | |||||||||
| Address1: | 1562 OPOSSUMTOWN PIKE | ||||||||
| Address2: | |||||||||
| City: | FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217024337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016628119 | ||||||||
| FaxNumber: | 3016960985 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2005 | ||||||||
| LastUpdateDate: | 04/30/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | D54705 | MD | N | Other Service Providers | Specialist | 207RP1001X | D0054705 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 1407838402 | 01 | MD | MEDICAID NPI | OTHER | 290012174 | 01 | MD | MEDICARE RAILROAD | OTHER | 283003500 | 05 | MD | MEDICAID |