MEDICARE: DR. LISA BRADLEY BUNTING MD

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	0101054467	VA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	231106	OTHER	VA	MDIPA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	006730761	OTHER	VA	VIRGINIA PREMIER
4	17808	OTHER	VA	OPTIMA FAMILY CARE
5	17808	OTHER	VA	FAMIS OPTIMA FAMILY CARE
6	231106	OTHER	VA	ALLIANCE
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	463534	OTHER	VA	FAMIS ANTHEM HK PLUS
9	17808	OTHER	VA	OPTIMA HEALTH PLAN
10	5300714	OTHER	VA	AETNA
11	006730761	OTHER	VA	FAMIS VIRGINIA PREMIER
12	231106	OTHER	VA	OPTIMUM CHOICE
13	463534	OTHER	VA	ANTHEM BCBS
14	463534	OTHER	VA	ANTHEM HK PLUS
15	5417787860141E	OTHER	VA	CIGNA
16	231106	OTHER	VA	MAMSI
17	541778786	OTHER	NC	NC HEALTH CHOICE

NPI Number	:	1912931593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA BRADLEY BUNTING MD

Provider Business Mailing Address
First Line	:	500 DISCOVERY DR
Second Line	:	SUITE 302
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320-3871
Country	:	US
Telephone Number	:	757-668-2500
Fax Number	:	757-668-2510

Provider Business Practice Location Address
First Line	:	500 DISCOVERY DR
Second Line	:	SUITE 302
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320-3871
Country	:	US
Telephone Number	:	757-668-2500
Fax Number	:	757-668-2510

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	01/10/2013

500 DISCOVERY DR
CHESAPEAKE, VA
23320-3871

Practice Phone: 757-668-2311
Practice Fax:

500 DISCOVERY DR STE 302
CHESAPEAKE, VA
23320-3871