Provider Demographics
NPI:1497002760
Name:BUNCH, CAREY ALAN (CPO)
Entity Type:Individual
Prefix:
First Name:CAREY
Middle Name:ALAN
Last Name:BUNCH
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 ELLIOTT ST
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29115-6022
Mailing Address - Country:US
Mailing Address - Phone:803-534-6567
Mailing Address - Fax:803-937-6566
Practice Address - Street 1:230 ELLIOTT ST
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-6022
Practice Address - Country:US
Practice Address - Phone:803-534-6567
Practice Address - Fax:803-937-6566
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7529830001Medicare PIN