Organization
FAMILY MEDICINE PARTERSHIP
Active
Other names
Bolton Familyand Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RONALD BUCKMAN MD (OWNER)
(860) 646-0649
Entity
Organization
Contact information
Practice address
921 BOSTON TPKE, STE A, BOLTON, CT 06043-7403
(860) 646-0649
(860) 649-1995
Mailing address
921 BOSTON TPKE, STE A, BOLTON, CT 06043-7403
(860) 646-0649
(860) 649-1995
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
5515
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004199825
—
CT
01
—
0308497007
CONNECTICARE
CT
Enumeration date
10/03/2013
Last updated
10/03/2013
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