Bertrand Nkafu Andukwa Ebunji, MD

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

0101279747 Issued in VA

Practice address

47149 Buse Rd BLDG 1370
Patuxent River, MD 20670-1540

Phone

(301) 342-0029

Fax

(301) 342-4054

NPI assigned

Jan 31, 2022

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1643587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712275200000",
    "number": "1629721667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47149 BUSE RD BLDG 1370",
            "city": "PATUXENT RIVER",
            "state": "MD",
            "postal_code": "206701540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "47149 BUSE RD BLDG 1370",
            "city": "PATUXENT RIVER",
            "state": "MD",
            "postal_code": "206701540",
            "telephone_number": "301-342-0029",
            "fax_number": "301-342-4054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EBUNJI",
        "first_name": "BERTRAND",
        "middle_name": "NKAFU ANDUKWA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-01-31",
        "last_updated": "2024-04-05",
        "certification_date": "2024-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "VA",
            "license": "0101279747",
            "primary": true
        },
        {
            "code": "171000000X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cordon Daley, LCSW-C
• Elizabeth Ann Davenport
• Alisha Deschenes, PA-C
• Bryan Dooley, MD
• Melissa Ann Dyson, DPT
• Steven Elek IV
• Bonnie S. Garbutt, O.D.
• Kassidy Garcia
• Ryan Gelsinger
• Bethany Jewell God, M.D.

• General Practice Physician in Patuxent River, MD
• Providers in Patuxent River, MD by specialty
• General Practice Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.