Individual
MIRIAM S. BUCKBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
701 ENFIELD STREET, ENFIELD, CT 06082
(860) 741-6058
(860) 253-9326
Mailing address
2150 MAIN STREET, SPRINGFIELD, MA 01104
(413) 739-5676
(413) 733-5860
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
017423
ME
207Q00000X
Family Medicine Physician
Primary
251720
MA
207Q00000X
Family Medicine Physician
35070556
OH
207R00000X
Internal Medicine Physician
64731
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080189297
RAILROAD MEDICARE NUMBER
OH
01
—
099883
ANTHEM ME
ME
05
—
2046637
—
OH
05
—
432710699
—
ME
01
—
AA99889
HPHC
ME
Enumeration date
12/16/2005
Last updated
01/31/2020
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