Basic Information
| Provider Information | |||||||||
| NPI: | 1467448555 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUCKLEY | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 421 W CHEW ST | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181023406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6107765315 | ||||||||
| FaxNumber: | 6106633113 | ||||||||
| Practice Location | |||||||||
| Address1: | 1210 HANOVER AVE | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181092017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104376490 | ||||||||
| FaxNumber: | 6104374151 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2005 | ||||||||
| LastUpdateDate: | 08/24/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD020876E | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01397201 | 01 | CBC | OTHER | 020766 | 01 | HIGHMARK BLUE SHIELD | OTHER | 0040768000 | 01 | IBC | OTHER | P003146 | 01 | GATEWAY | OTHER | 0017586300001 | 05 | PA | MEDICAID | 1129063 | 01 | AMERIHEALTH MERCY HEALTH | OTHER |