Provider Demographics
NPI:1871559567
Name:BUCKLEY, RONALD (DO)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:BUCKLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7068
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-0068
Mailing Address - Country:US
Mailing Address - Phone:757-686-3508
Mailing Address - Fax:757-686-0541
Practice Address - Street 1:2000 MEADE PARKWAY
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-4259
Practice Address - Country:US
Practice Address - Phone:757-539-0251
Practice Address - Fax:757-923-9602
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102200838207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA070013557OtherRAILROAD MEDICARE
NC690582UMedicaid
VA5901553Medicaid
VA5901553Medicaid
VA070013557OtherRAILROAD MEDICARE