Healthcare Provider Details

I. General information

NPI: 1184699522
Provider Name (Legal Business Name): TIMOTHY E BUNCHMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PERKINS SQ
AKRON OH
44308-1063
US

IV. Provider business mailing address

PO BOX 980498
RICHMOND VA
23291-1734
US

V. Phone/Fax

Practice location:
  • Phone: 330-543-0541
  • Fax: 330-543-3270
Mailing address:
  • Phone: 804-827-2264
  • Fax: 804-628-5853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number4301057213
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number35.0744921
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number35.074921
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number0101249083
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: