National Provider Identifier
Mary Bucknam, P.A.
Mary Bucknam, P.A. is listed in the NPPES registry with a primary specialty of Medical Physician Assistant in Ithaca, NY and a listed phone number of (607) 272-6880.
Profile Overview
- NPI
- 1104906726
- Provider Type
- Individual
- Primary Specialty
- Medical Physician Assistant
- Enumeration Date
- October 17, 2006
- Last Updated
- July 08, 2007
Practice Location
- 1301 Trumansburg RD
- Suite H
- Ithaca, NY 14850-1397
Phone: (607) 272-6880
Specialties
- Medical Physician Assistant (363AM0700X)
Full Record
- NPI
- 1104906726
- Entity Type
- Individual
- Last Name
- Bucknam
- First Name
- Mary
- Credential
- P.A.
- Mailing Street Address
- 1301 Trumansburg RD
- Mailing Address Line 2
- Suite H
- Mailing City
- Ithaca
- Mailing State
- NY
- Mailing ZIP Code
- 14850-1397
- Mailing Country
- US
- Mailing Phone
- (607) 272-6880
- Mailing Fax
- (607) 272-1436
- Practice Street Address
- 1301 Trumansburg RD
- Practice Address Line 2
- Suite H
- Practice City
- Ithaca
- Practice State
- NY
- Practice ZIP Code
- 14850-1397
- Practice Country
- US
- Practice Phone
- (607) 272-6880
- Practice Fax
- (607) 272-1436
- Enumeration Date
- October 17, 2006
- Last Updated
- July 08, 2007
- Sex
- Female
- Sole Proprietor
- No
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Medical Physician Assistant (363AM0700X)
- Other Identifiers
- 02060933 (NY)