Provider Demographics
NPI:1730541129
Name:BUCKINGHAM PRIMARY HEALTHCARE
Entity type:Organization
Organization Name:BUCKINGHAM PRIMARY HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MARINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:267-406-4422
Mailing Address - Street 1:2325 HERITAGE CENTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FURLONG
Mailing Address - State:PA
Mailing Address - Zip Code:18925-1262
Mailing Address - Country:US
Mailing Address - Phone:267-406-4422
Mailing Address - Fax:267-406-4423
Practice Address - Street 1:2325 HERITAGE CENTER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:FURLONG
Practice Address - State:PA
Practice Address - Zip Code:18925-1262
Practice Address - Country:US
Practice Address - Phone:267-406-4422
Practice Address - Fax:267-406-4423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-24
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA502725Medicare PIN