John William Buckley Jr., M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

D0013364 Issued in MD

Practice address

5220 Long Green Rd
Glen Arm, MD 21057-9716

Phone

(410) 592-5955

NPI assigned

Dec 19, 2006

Last updated

Jul 8, 2007By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Feb 1, 2013 through Feb 1, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: jbuckley139463@direct.umm.edu

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1912060179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5220 LONG GREEN RD",
            "city": "GLEN ARM",
            "state": "MD",
            "postal_code": "210579716",
            "telephone_number": "410-592-5955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5220 LONG GREEN RD",
            "city": "GLEN ARM",
            "state": "MD",
            "postal_code": "210579716",
            "telephone_number": "410-592-5955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUCKLEY",
        "first_name": "JOHN",
        "middle_name": "WILLIAM",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MD",
            "license": "D0013364",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mina Baradaran Alizadeh, D.D.S.
• Jennifer Barker, MS CCC-SLP
• Maura Barry, OTR/L
• Benchmark Therapy, Inc.
• Amy Burton, MS, CCC-SLP
• Christine Nelson
• Coates Freedom Minded Consulting Agency, LLC
• Shutic Coates, LCSW-C
• Hannah Connelly, OTR/L

• Psychiatry Physician in Glen Arm, MD
• Providers in Glen Arm, MD by specialty
• Psychiatry Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.