Healthcare Provider Details

I. General information

NPI: 1033572250
Provider Name (Legal Business Name): ANDY CAMERON BUNCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 07/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4092 FOXWOOD DR STE 101
VIRGINIA BEACH VA
23462-5225
US

IV. Provider business mailing address

4092 FOXWOOD DR STE 101
VIRGINIA BEACH VA
23462-5225
US

V. Phone/Fax

Practice location:
  • Phone: 757-467-4200
  • Fax:
Mailing address:
  • Phone: 757-467-4200
  • Fax: 757-467-4173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101266619
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: