Provider Demographics
NPI:1730165218
Name:BUNT, BRIAN R (DPM)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:R
Last Name:BUNT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400B HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-3026
Mailing Address - Country:US
Mailing Address - Phone:540-347-1370
Mailing Address - Fax:540-349-4801
Practice Address - Street 1:400B HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-3026
Practice Address - Country:US
Practice Address - Phone:540-347-1370
Practice Address - Fax:540-349-4801
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000604213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009302166Medicaid
VA009302166Medicaid
VA480000316Medicare PIN
VA0596180002Medicare NSC