Provider Demographics
NPI:1912931593
Name:BUNTING, LISA BRADLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:BRADLEY
Last Name:BUNTING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:C
Other - Last Name:BRADLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 DISCOVERY DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3871
Mailing Address - Country:US
Mailing Address - Phone:757-668-2500
Mailing Address - Fax:757-668-2510
Practice Address - Street 1:500 DISCOVERY DR
Practice Address - Street 2:SUITE 302
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3871
Practice Address - Country:US
Practice Address - Phone:757-668-2500
Practice Address - Fax:757-668-2510
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101054467208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA231106OtherMDIPA
NC790617UMedicaid
VA006730761OtherVIRGINIA PREMIER
VA17808OtherOPTIMA FAMILY CARE
VA17808OtherFAMIS OPTIMA FAMILY CARE
VA231106OtherALLIANCE
VA006730761Medicaid
VA463534OtherFAMIS ANTHEM HK PLUS
VA17808OtherOPTIMA HEALTH PLAN
VA5300714OtherAETNA
VA006730761OtherFAMIS VIRGINIA PREMIER
VA231106OtherOPTIMUM CHOICE
VA463534OtherANTHEM BCBS
VA463534OtherANTHEM HK PLUS
VA5417787860141EOtherCIGNA
VA231106OtherMAMSI
NC541778786OtherNC HEALTH CHOICE
VA17808OtherFAMIS OPTIMA FAMILY CARE