Provider Demographics
NPI:1659093763
Name:BUNTING, ZIVAGO Z (DNP)
Entity type:Individual
Prefix:
First Name:ZIVAGO
Middle Name:Z
Last Name:BUNTING
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:DR
Other - First Name:ZIVAGO
Other - Middle Name:
Other - Last Name:BUNTING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP, APRN, PMHNP-BC
Mailing Address - Street 1:12301 OLD COLUMBIA PIKE STE 104
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1619
Mailing Address - Country:US
Mailing Address - Phone:240-444-6110
Mailing Address - Fax:949-695-3130
Practice Address - Street 1:12301 OLD COLUMBIA PIKE STE 104
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-1619
Practice Address - Country:US
Practice Address - Phone:240-444-6110
Practice Address - Fax:949-695-3130
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-15
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR150087363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health