Individual
BLAINE DAVID BUCHANAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
225 E WOOD ST, SPARTANBURG, SC 29303-3050
(864) 560-4420
(864) 560-5296
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
0010-05930
NC
363AS0400X
Surgical Physician Assistant
Primary
3234
SC
363AS0400X
Surgical Physician Assistant
TL3234
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3204PA
—
SC
01
—
SCF5735019
MEDICARE PIN
SC
Enumeration date
09/01/2015
Last updated
12/08/2020
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