Provider Demographics
NPI:1184699522
Name:BUNCHMAN, TIMOTHY E (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:E
Last Name:BUNCHMAN
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:PO BOX 980498
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23291-1734
Mailing Address - Country:US
Mailing Address - Phone:804-827-2264
Mailing Address - Fax:804-628-5853
Practice Address - Street 1:1 PERKINS SQ
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308-1063
Practice Address - Country:US
Practice Address - Phone:330-543-0541
Practice Address - Fax:330-543-3270
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010572132080P0210X
OH35.07449212080P0210X
OR35.0749212080P0210X
VA01012490832080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1558407189OtherGROUP PIN
MI4514164Medicaid
MI350D176310OtherBCBS
MI4514164Medicaid
MI1558407189OtherGROUP PIN