John Joseph Buckley Jr., M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

3504815113 Issued in OH

Practice address

935 Trailwood Dr
Boardman, OH 44512-5062

Phone

(330) 758-8146

Fax

(330) 758-1399

NPI assigned

Oct 31, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211414400000",
    "number": "1114918133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 WILDFERN DR",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445051661",
            "telephone_number": "330-759-2048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "935 TRAILWOOD DR",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445125062",
            "telephone_number": "330-758-8146",
            "fax_number": "330-758-1399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUCKLEY",
        "first_name": "JOHN",
        "middle_name": "JOSEPH",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-31",
        "last_updated": "2008-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "OH",
            "license": "3504815113",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0631169",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emily Brothers Cope, LMT
• Kristopher Brown, PSY.D., BCBA-D, LP
• Mary Katherine Brown, MS
• Andrea Browne, DMD
• Susan Brownlee
• Elijah Lamont Burch
• Thomas L Burkes
• Michael Burkett
• Andrew W Bushey, DMD, MD
• Sunaina Buttar

• Specialist in Boardman, OH
• Providers in Boardman, OH by specialty
• Specialist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.