Provider Demographics
NPI:1821151804
Name:RUNDUS, VICTORIA RAE (MD)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:RAE
Last Name:RUNDUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:648 HARTSVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066
Mailing Address - Country:US
Mailing Address - Phone:615-451-9246
Mailing Address - Fax:615-575-5040
Practice Address - Street 1:648 HARTSVILLE PIKE
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066
Practice Address - Country:US
Practice Address - Phone:615-451-9246
Practice Address - Fax:615-575-5040
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD36930208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1510381Medicaid
TNBR8292120OtherDEA
TNH81491Medicare UPIN
TNBR8292120OtherDEA