Provider Demographics
NPI:1306184676
Name:WILLIAM W. FUNDERBURK, MD FACS PC
Entity Type:Organization
Organization Name:WILLIAM W. FUNDERBURK, MD FACS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:WATSON
Authorized Official - Last Name:FUNDERBURK
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:202-269-1143
Mailing Address - Street 1:1160 VARNUM ST NE
Mailing Address - Street 2:211
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2107
Mailing Address - Country:US
Mailing Address - Phone:202-269-1143
Mailing Address - Fax:202-269-3233
Practice Address - Street 1:1160 VARNUM ST NE
Practice Address - Street 2:211
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2107
Practice Address - Country:US
Practice Address - Phone:202-269-1143
Practice Address - Fax:202-269-3233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD25208208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty