Individual
JOEL T BUNDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
745 BATTLEFIELD BLVD N, CHESAPEAKE, VA 23320-0305
(757) 623-0005
(757) 410-7349
Mailing address
1228 PROGRESSIVE DR, STE 101, CHESAPEAKE, VA 23320-2846
(757) 623-0005
(757) 410-7349
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
9901131
NC
207R00000X
Internal Medicine Physician
010149860
VA
207RN0300X
Nephrology Physician
Primary
0101049860
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006098100
—
VA
01
—
2023717
MEDICARE
NC
01
—
541371648
TAXID #
VA
Enumeration date
06/28/2005
Last updated
04/16/2012
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