Provider Demographics
NPI:1730270851
Name:BUCHSBAUM, MARION EVA (MD)
Entity type:Individual
Prefix:
First Name:MARION
Middle Name:EVA
Last Name:BUCHSBAUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 BEDFORD STREET
Mailing Address - Street 2:STE 211
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420
Mailing Address - Country:US
Mailing Address - Phone:781-862-2322
Mailing Address - Fax:781-863-0927
Practice Address - Street 1:57 BEDFORD STREET
Practice Address - Street 2:STE 211
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420
Practice Address - Country:US
Practice Address - Phone:781-862-2322
Practice Address - Fax:781-863-0927
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77498207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA401473OtherHARV PIL
MA077498OtherTUFTS
MAJ14044Medicare ID - Type Unspecified
MA401473OtherHARV PIL