Healthcare Provider Details

I. General information

NPI: 1164402459
Provider Name (Legal Business Name): JUNE R. TUNSTALL, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 HOPEWELL ST
HOPEWELL VA
23860-2817
US

IV. Provider business mailing address

401 HOPEWELL ST
HOPEWELL VA
23860-2817
US

V. Phone/Fax

Practice location:
  • Phone: 804-458-6396
  • Fax: 804-458-4934
Mailing address:
  • Phone: 804-458-6396
  • Fax: 804-458-4934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101029877
License Number StateVA

VIII. Authorized Official

Name: JUNE REBECCA TUNSTALL
Title or Position: OWNER
Credential: MD
Phone: 804-458-6396