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General NPI Number Information
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NPI Number | 1962400630
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Entity Type | Individual
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Provider Name | ROBERT JOSEPH BUNDY M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/07/2005
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Last Update Date | 01/27/2015
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Provider Practice Location Address
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Address Line | 112 MANSFIELD AVE PULMONARY DEPT., HATCH WING
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City | WILLIMANTIC
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State | CT
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Zip | 06226-2041
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Country | US
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Telephone | 860-456-7279
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Fax | 860-450-0269
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Provider Business Mailing Address
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Address Line | 112 MANSFIELD AVE PULMONARY DEPT., HATCH WING
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City | WILLIMANTIC
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State | CT
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Zip | 06226-2041
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Country | US
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Telephone | 860-456-7279
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Fax | 860-450-0269
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 25147
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License Number State | CT
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