Provider Demographics
NPI:1043438468
Name:BUCHANAN, MARTHA (MD)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:BUCHANAN
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 1:3685 RIVERS AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-8057
Mailing Address - Country:US
Mailing Address - Phone:803-210-0607
Mailing Address - Fax:
Practice Address - Street 1:3685 RIVERS AVE
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-8057
Practice Address - Country:US
Practice Address - Phone:865-215-5313
Practice Address - Fax:865-215-5099
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC89785207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3808054Medicare ID - Type Unspecified
TNF88463Medicare UPIN