Provider Demographics
NPI:1962400630
Name:BUNDY, ROBERT JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOSEPH
Last Name:BUNDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:112 MANSFIELD AVE
Mailing Address - Street 2:PULMONARY DEPT., HATCH WING
Mailing Address - City:WILLIMANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06226-2041
Mailing Address - Country:US
Mailing Address - Phone:860-456-7279
Mailing Address - Fax:860-450-0269
Practice Address - Street 1:112 MANSFIELD AVE
Practice Address - Street 2:PULMONARY DEPT., HATCH WING
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-2041
Practice Address - Country:US
Practice Address - Phone:860-456-7279
Practice Address - Fax:860-450-0269
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT25147207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001251479Medicaid
CT1962400630OtherNPI
CT001251479Medicaid
CTD400080769Medicare PIN