Active NPI
Watta D Bundor
- Social Worker
- Baltimore, MD
National Provider Identifier
1255840823
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 23324
- Practice address
- 22 S Greene St
Baltimore, MD 21201 - Phone
- (410) 328-8667
- NPI assigned
- Sep 26, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 23324 | MD | Primary |
Addresses
Primary practice location
22 S Greene St
Baltimore, MD 21201
Mailing address
7108 24TH PL
Hyattsville, MD 20783-2705
Phone (301) 257-5311
Other practice location 1
809 Eastern Shore Dr
Salisbury, MD 21804-5934
Phone (844) 224-5264 ext. 673
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255840823 | Medicaid | MD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23324 | MD | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1506384000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1530489600000",
"number": "1255840823",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7108 24TH PL",
"city": "HYATTSVILLE",
"state": "MD",
"postal_code": "207832705",
"telephone_number": "301-257-5311"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22 S GREENE ST",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "21201",
"telephone_number": "410-328-8667"
}
],
"practiceLocations": [
{
"address_1": "809 Eastern Shore Dr",
"address_purpose": "LOCATION",
"city": "Salisbury",
"state": "MD",
"postal_code": "218045934",
"country_code": "US",
"telephone_number": "844-224-5264 x673",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BUNDOR",
"first_name": "WATTA",
"middle_name": "D",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-09-26",
"last_updated": "2018-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MD",
"license": "23324",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1255840823",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.