Provider Demographics
NPI:1144303579
Name:BUCHLIS, JOHN GEORGIOU (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:GEORGIOU
Last Name:BUCHLIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 MAIN ST FL 5
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1009
Mailing Address - Country:US
Mailing Address - Phone:716-323-0170
Mailing Address - Fax:716-323-0297
Practice Address - Street 1:1001 MAIN ST FL 4
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1009
Practice Address - Country:US
Practice Address - Phone:716-323-0170
Practice Address - Fax:716-323-0297
Is Sole Proprietor?:No
Enumeration Date:2006-10-21
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196898208000000X, 2080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IHAOther4509252
00010306101OtherUNIVERA
000524880001OtherBC/BS
PA0016886330001Medicaid
NY01752170Medicaid
040426001452OtherFIDELIS
NY01752170Medicaid
NY14316FMedicare PIN