Provider Demographics
NPI:1326418781
Name:BUNCH, MEGAN DIMINICH (PA)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:DIMINICH
Last Name:BUNCH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:MEGAN
Other - Last Name:DIMINISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:21 BURNS LN
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29401-1492
Mailing Address - Country:US
Mailing Address - Phone:843-779-8570
Mailing Address - Fax:
Practice Address - Street 1:21 BURNS LN
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-1492
Practice Address - Country:US
Practice Address - Phone:843-779-8570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2428363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant