Active NPI
Frederick Oliver Buckley Jr., M.D.
- Surgery Physician
- Danvers, MA
National Provider Identifier
1013905025
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 44363
- Practice address
- 104 Endicott St
Suite 200
Danvers, MA 01923-3623 - Phone
- (978) 882-6868
- Fax
- (978) 882-6828
- NPI assigned
- Oct 12, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 44363 | MA | Primary |
Addresses
Primary practice location
104 Endicott St
Suite 200
Danvers, MA 01923-3623
Mailing address
104 Endicott St
Suite 200
Danvers, MA 01923-3623
Phone (978) 882-6868
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2071843 | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 44363 | MA | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Essex Surgical Associates, PC | Surgery | Past | Accepting new patients |
| Surgical Specialists of the North Shore,Inc | Surgery | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Surgery Physician
- Beverly, MA
- NPI 1003823105
-
- Surgery Physician
- Salem, MA
- NPI 1619936531
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129075200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1337299200000",
"number": "1013905025",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "104 ENDICOTT ST",
"address_2": "SUITE 200",
"city": "DANVERS",
"state": "MA",
"postal_code": "019233623",
"telephone_number": "978-882-6868",
"fax_number": "978-882-6828"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "104 ENDICOTT ST",
"address_2": "SUITE 200",
"city": "DANVERS",
"state": "MA",
"postal_code": "019233623",
"telephone_number": "978-882-6868",
"fax_number": "978-882-6828"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUCKLEY",
"first_name": "FREDERICK",
"middle_name": "OLIVER",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-12",
"last_updated": "2012-05-18",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "MA",
"license": "44363",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2071843",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Danvers, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.