Provider Demographics
NPI:1871561092
Name:BUCKMAN, RONALD L (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:L
Last Name:BUCKMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 BOSTON TPKE
Mailing Address - Street 2:
Mailing Address - City:BOLTON
Mailing Address - State:CT
Mailing Address - Zip Code:06043-7403
Mailing Address - Country:US
Mailing Address - Phone:860-646-0649
Mailing Address - Fax:860-649-9195
Practice Address - Street 1:921 BOSTON TPKE
Practice Address - Street 2:
Practice Address - City:BOLTON
Practice Address - State:CT
Practice Address - Zip Code:06043-7403
Practice Address - Country:US
Practice Address - Phone:860-646-0649
Practice Address - Fax:860-649-9195
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT022901207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001229012Medicaid
CT022901OtherLICENSE
CT080000126Medicare ID - Type Unspecified
CT022901OtherLICENSE