Healthcare Provider Details

I. General information

NPI: 1821074899
Provider Name (Legal Business Name): BRADLEY LE BLANG BUNTEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 HOSPITAL DR
WARRENTON VA
20186-3027
US

IV. Provider business mailing address

9241 COPENHAVER DR
POTOMAC MD
20854-3016
US

V. Phone/Fax

Practice location:
  • Phone: 540-316-5707
  • Fax:
Mailing address:
  • Phone: 760-213-5060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD-9827
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: