Provider Demographics
NPI:1154384147
Name:GARCIA-BUNUEL, MARTIN LUIS (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:LUIS
Last Name:GARCIA-BUNUEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-1646
Mailing Address - Country:US
Mailing Address - Phone:410-228-3965
Mailing Address - Fax:
Practice Address - Street 1:830 CHESAPEAKE DR
Practice Address - Street 2:VA MARYLAND HEALTHCARE SYSTEM
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-9408
Practice Address - Country:US
Practice Address - Phone:410-228-6243
Practice Address - Fax:410-901-4070
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0057290207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH48675Medicare UPIN
MDS135B903Medicare ID - Type Unspecified