Provider Demographics
NPI:1437235066
Name:BUNCH, VELMA L (PA)
Entity Type:Individual
Prefix:
First Name:VELMA
Middle Name:L
Last Name:BUNCH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 CENTRAL PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4942
Mailing Address - Country:US
Mailing Address - Phone:540-785-9500
Mailing Address - Fax:866-601-0609
Practice Address - Street 1:1320 CENTRAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4942
Practice Address - Country:US
Practice Address - Phone:540-785-9500
Practice Address - Fax:866-601-0609
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001907363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010128749Medicaid
C10275OtherMEDICARE GROUPS
VI0110001907OtherLICENSE
C10275OtherMEDICARE GROUPS
VA010128749Medicaid