Provider Demographics
NPI:1508839499
Name:WUNDER, NICHOLAS FRANCIS (PA-C)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:FRANCIS
Last Name:WUNDER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 COX RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-9263
Mailing Address - Country:US
Mailing Address - Phone:804-968-5700
Mailing Address - Fax:
Practice Address - Street 1:995 HOSPITALITY WAY
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-1755
Practice Address - Country:US
Practice Address - Phone:410-306-7880
Practice Address - Fax:410-306-7881
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002595363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD344498YWV2Medicare PIN
MD489PR226Medicare PIN
MD235222YVZMedicare PIN
PA477229YUNMMedicare PIN
PA477229YEBKMedicare PIN
MD235223ZDDBMedicare PIN
NJ504059ZPCNMedicare PIN