Provider Demographics
NPI:1770571390
Name:BUXBAUM, JODIE L (MD)
Entity type:Individual
Prefix:
First Name:JODIE
Middle Name:L
Last Name:BUXBAUM
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 1:4905 W TILGHMAN ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-9130
Mailing Address - Country:US
Mailing Address - Phone:484-866-9583
Mailing Address - Fax:610-366-1147
Practice Address - Street 1:4905 W TILGHMAN ST
Practice Address - Street 2:SUITE 250
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-9130
Practice Address - Country:US
Practice Address - Phone:484-866-9583
Practice Address - Fax:610-366-1147
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045451L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2000610OtherKHP CENTRAL
PA720767OtherHIGHMARK
PA01537861OtherGATEWAY
PA30016652OtherKEYSTONE MERCY
PA000000156446OtherTHREE RIVERS
PA0012836440008Medicaid
PA20035354OtherAMERIHEALTH MERCY
PA0557923000OtherINDEP. BLUE CROSS
PA01537861OtherGATEWAY
PA0012836440008Medicaid
PAP00136008Medicare PIN