Provider Demographics
NPI:1942273909
Name:BUSH, JAMES A (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:BUSH
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 1:815 W POYTHRESS ST
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:23860-2532
Mailing Address - Country:US
Mailing Address - Phone:804-458-8557
Mailing Address - Fax:804-541-7113
Practice Address - Street 1:815 W POYTHRESS ST
Practice Address - Street 2:
Practice Address - City:HOPEWELL
Practice Address - State:VA
Practice Address - Zip Code:23860-2532
Practice Address - Country:US
Practice Address - Phone:804-458-8557
Practice Address - Fax:804-541-7113
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057876207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005860474Medicaid
VA319839OtherANTHEM
VAVV13549844Medicare PIN
VA003922D92Medicare PIN
VA110232664Medicare PIN
VA005860474Medicaid