Healthcare Provider Details

I. General information

NPI: 1114063393
Provider Name (Legal Business Name): MARGRIET BUNGER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20925 PROFESSIONAL PLZ SUITE 340
ASHBURN VA
20147-3403
US

IV. Provider business mailing address

1922 KENBAR CT
MCLEAN VA
22101-5321
US

V. Phone/Fax

Practice location:
  • Phone: 703-723-8900
  • Fax: 703-723-8400
Mailing address:
  • Phone: 703-241-1254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101044128
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: