MEDICARE: NICHOLAS BUNKER TAINTOR MD

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	2084P0800X	Psychiatry Physician	251050	NY
2	2084P0800X	Psychiatry Physician	0101255825	VA

General Provider Information

NPI Number	:	1629268677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS BUNKER TAINTOR MD

Provider Business Mailing Address
First Line	:	2120 WASHINGTON BLVD
Second Line	:	3RD FLOOR
City	:	ARLINGTON
State	:	VA
Zip	:	22204-5718
Country	:	US
Telephone Number	:	703-228-5169
Fax Number	:	703-543-9405

Provider Business Practice Location Address
First Line	:	2120 WASHINGTON BLVD
Second Line	:	3RD FLOOR
City	:	ARLINGTON
State	:	VA
Zip	:	22204-5718
Country	:	US
Telephone Number	:	703-228-5169
Fax Number	:	703-543-9405

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

Provider Enumeration Date	:	07/26/2007
Last Update Date	:	04/19/2016

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