Basic Information
| Provider Information | |||||||||
| NPI: | 1558543595 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUCHANAN | ||||||||
| FirstName: | GORDON | ||||||||
| MiddleName: | FRANK | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD, PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 YORK ST | ||||||||
| Address2: | LCI-916 | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037854085 | ||||||||
| FaxNumber: | 2037856246 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 YORK ST | ||||||||
| Address2: | T-209 | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065103220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036882259 | ||||||||
| FaxNumber: | 2036885599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2007 | ||||||||
| LastUpdateDate: | 03/24/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 046592 | CT | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.