Provider Demographics
NPI:1194709378
Name:BUNDY, ALBERT THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:THOMAS
Last Name:BUNDY
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 1:15 HOSPITAL CENTER BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29926-2727
Mailing Address - Country:US
Mailing Address - Phone:843-689-9200
Mailing Address - Fax:843-689-9201
Practice Address - Street 1:15 HOSPITAL CENTER BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29926-2727
Practice Address - Country:US
Practice Address - Phone:843-689-9200
Practice Address - Fax:843-689-9201
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14710174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTL4652Medicaid
SCE825905013Medicare PIN
SCE82590Medicare UPIN