Individual
MICHAEL BUXBAUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
116 S MAIN ST, NORTH WALES, PA 19459
(215) 699-1206
(215) 699-1206
Mailing address
P O BOX 42, GWYNEDD, PA 19436-0042
(215) 442-5500
(215) 442-1641
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD039175L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000991520006
—
PA
01
—
0040523000
KEYSTONE
PA
01
—
104436
BLUE SHIELD
PA
Enumeration date
02/28/2006
Last updated
11/20/2008
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