Provider Demographics
NPI:1043320815
Name:BUCKNOR, YETUNDE (MD)
Entity type:Individual
Prefix:
First Name:YETUNDE
Middle Name:
Last Name:BUCKNOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8665 GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3405
Mailing Address - Country:US
Mailing Address - Phone:301-340-7525
Mailing Address - Fax:301-495-0318
Practice Address - Street 1:220 GIRARD ST STE 100
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-3467
Practice Address - Country:US
Practice Address - Phone:301-216-0880
Practice Address - Fax:301-216-2891
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0075721208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics