Provider Demographics
NPI:1750586343
Name:BUNICK, ELAINE MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:MARIE
Last Name:BUNICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 NEW YORK AVE
Mailing Address - Street 2:SUITE #160
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-5212
Mailing Address - Country:US
Mailing Address - Phone:865-483-5639
Mailing Address - Fax:865-483-9346
Practice Address - Street 1:200 NEW YORK AVE
Practice Address - Street 2:SUITE #160
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-5212
Practice Address - Country:US
Practice Address - Phone:865-483-5639
Practice Address - Fax:865-483-9346
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD11035174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3166763Medicaid
TN3386121Medicaid
TNB03194Medicare UPIN
TN3166764Medicare Oscar/Certification