Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mary Bucknam, PA

Individual provider Medical Physician Assistant · NPI 1104906726

Mary Bucknam, PA is a Medical Physician Assistant in Ithaca, New York. Licensed in New York. Registered with an NPI since 2006.

Licensed in
NY
In the registry since
2006
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

1301 Trumansburg Rd Ste H
Ithaca, NY 14850-1397
Phone: (607) 272-6880
Fax: (607) 272-1436
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence 0032601 (NY)

Record details

NPI number1104906726
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedOctober 17, 2006
Last updated in NPPESJuly 8, 2007

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