MEDICARE: ZACHARY M. BUSH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	0101239018	VA
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	0101239018	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588733109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZACHARY M. BUSH M.D.

Provider Business Mailing Address
First Line	:	3048 ALBERENE CHURCH LN
Second Line	:
City	:	ESMONT
State	:	VA
Zip	:	22937-1516
Country	:	US
Telephone Number	:	434-566-7628
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 RAY C HUNT DR
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22903-2980
Country	:	US
Telephone Number	:	434-924-1825
Fax Number	:	434-924-9616

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	05/13/2010

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