Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | 0101249083 | VA |
N | 2080P0210X | Pediatric Nephrologist | 4301057213 | MI |
NPI | 1184699522 |
---|---|
Provider Name | Timothy E Bunchman |
First Address | Richmond, VA 23291-1734 |
Second Address | Richmond, VA 23298-5051 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2006 |
Last Update Date | 10/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1558407189 | GROUP PIN (01) | MI |
350D176310 | BCBS (01) | MI |
4514164 | (05) | MI |
A13399 | (02) | MI |