Provider Demographics
NPI:1679227029
Name:HARLEY, BUZZ MATTHEW
Entity type:Individual
Prefix:MR
First Name:BUZZ
Middle Name:MATTHEW
Last Name:HARLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7816 MARLBORO PIKE
Mailing Address - Street 2:
Mailing Address - City:FORESTVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20747-4412
Mailing Address - Country:US
Mailing Address - Phone:240-553-5870
Mailing Address - Fax:
Practice Address - Street 1:7816 MARLBORO PIKE
Practice Address - Street 2:
Practice Address - City:FORESTVILLE
Practice Address - State:MD
Practice Address - Zip Code:20747-4412
Practice Address - Country:US
Practice Address - Phone:240-535-8707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service