Provider Demographics
NPI:1245480318
Name:BUNCH, AUDREY LUDWIG (PA-C, MS)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:LUDWIG
Last Name:BUNCH
Suffix:
Gender:F
Credentials:PA-C, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:28 BLACKWELL PARK LN
Mailing Address - Street 2:SUITE 302
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-2685
Mailing Address - Country:US
Mailing Address - Phone:540-341-1900
Mailing Address - Fax:540-341-0940
Practice Address - Street 1:28 BLACKWELL PARK LN
Practice Address - Street 2:SUITE 302
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-2685
Practice Address - Country:US
Practice Address - Phone:540-341-1900
Practice Address - Fax:540-341-0940
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDC0003830363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1245480318Medicaid
VA1245480318Medicaid