Provider Demographics
NPI:1932105517
Name:BUNDY, JOEL T (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:T
Last Name:BUNDY
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 1:1228 PROGRESSIVE DR
Mailing Address - Street 2:STE 101
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2846
Mailing Address - Country:US
Mailing Address - Phone:757-623-0005
Mailing Address - Fax:757-410-7349
Practice Address - Street 1:745 BATTLEFIELD BLVD N
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-0305
Practice Address - Country:US
Practice Address - Phone:757-623-0005
Practice Address - Fax:757-410-7349
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA010149860207R00000X
VA0101049860207RN0300X
NC9901131174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2023717OtherMEDICARE
VA006098100Medicaid
VA541371648OtherTAXID #
VA541371648OtherTAXID #
VA390000140Medicare ID - Type Unspecified