Basic Information
| Provider Information | |||||||||
| NPI: | 1952369449 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUESCHER | ||||||||
| FirstName: | PHILIP | ||||||||
| MiddleName: | CLAY | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 FAIRMOUNT AVENUE | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | TOWSON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21286 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4104947921 | ||||||||
| FaxNumber: | 4109028247 | ||||||||
| Practice Location | |||||||||
| Address1: | 515 FAIRMOUNT AVE STE 500 | ||||||||
| Address2: | |||||||||
| City: | TOWSON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212865466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4104941662 | ||||||||
| FaxNumber: | 4104941718 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 06/23/2017 | ||||||||
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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 | 207RP1001X | D29565 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 329271100 | 05 | MD | MEDICAID | K531149R | 01 | MD | MEDICARE ID | OTHER |