Healthcare Provider Details

I. General information

NPI: 1932105517
Provider Name (Legal Business Name): JOEL T BUNDY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 04/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 BATTLEFIELD BLVD N
CHESAPEAKE VA
23320-0305
US

IV. Provider business mailing address

1228 PROGRESSIVE DR STE 101
CHESAPEAKE VA
23320-2846
US

V. Phone/Fax

Practice location:
  • Phone: 757-623-0005
  • Fax: 757-410-7349
Mailing address:
  • Phone: 757-623-0005
  • Fax: 757-410-7349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number010149860
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number0101049860
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number9901131
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: