Provider Demographics
NPI:1679993083
Name:BUCHANAN, MADISON (MD)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1565 48TH AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-2850
Mailing Address - Country:US
Mailing Address - Phone:214-336-7086
Mailing Address - Fax:
Practice Address - Street 1:45 SAN CLEMENTE DR STE A200
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1204
Practice Address - Country:US
Practice Address - Phone:415-494-9165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-24
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1560512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry