Basic Information
| Provider Information | |||||||||
| NPI: | 1184699522 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUNCHMAN | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 91734 | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232911734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8043586100 | ||||||||
| FaxNumber: | 8043427619 | ||||||||
| Practice Location | |||||||||
| Address1: | 1250 E MARSHALL ST | ||||||||
| Address2: | PEDIATRICS | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232985051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8048283744 | ||||||||
| FaxNumber: | 8048286455 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2006 | ||||||||
| LastUpdateDate: | 03/10/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0210X | 4301057213 | MI | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Nephrology | 2080P0210X | 0101249083 | VA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 1558407189 | 01 | MI | GROUP PIN | OTHER | 350D176310 | 01 | MI | BCBS | OTHER | 4514164 | 05 | MI | MEDICAID |