Provider Demographics
NPI:1013446590
Name:BUNTINX, TAL (MD)
Entity Type:Individual
Prefix:
First Name:TAL
Middle Name:
Last Name:BUNTINX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TALAYESA
Other - Middle Name:
Other - Last Name:BUNTINX KRIEG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:102 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-5237
Mailing Address - Country:US
Mailing Address - Phone:401-239-1800
Mailing Address - Fax:401-239-1801
Practice Address - Street 1:102 VALLEY RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-5237
Practice Address - Country:US
Practice Address - Phone:401-239-1800
Practice Address - Fax:401-239-1801
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD17705207N00000X
RILP03995207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine