Provider Demographics
NPI:1629268677
Name:TAINTOR, NICHOLAS BUNKER (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:BUNKER
Last Name:TAINTOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 WASHINGTON BLVD
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-5718
Mailing Address - Country:US
Mailing Address - Phone:703-228-5169
Mailing Address - Fax:703-543-9405
Practice Address - Street 1:2120 WASHINGTON BLVD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-5718
Practice Address - Country:US
Practice Address - Phone:703-228-5169
Practice Address - Fax:703-543-9405
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2510502084P0800X
VA01012558252084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry