Individual provider · Type 1 NPI

Mary Bucknam, P.A.

Medical Physician Assistant · Ithaca, NY

NPI number 1104906726 Active

Practice location

1301 Trumansburg Rd, Suite H
Ithaca, NY 14850-1397

Fax (607) 272-1436

Specialties and licenses

TaxonomyCodeLicense
Medical Physician Assistant Primary 363AM0700X0032601 (NY)

Medical Physician Assistant: Definition to come...

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About NPI 1104906726

Mary Bucknam, P.A.'s National Provider Identifier is 1104906726, issued on Oct 17, 2006. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Ithaca, NY. The record was last updated on Jul 8, 2007.