Robert Joseph Bundy, M.D.
Individual provider Active NPI Pulmonary Disease Physician · Willimantic, CT
NPI 1962400630 · NPPES record last updated Jan 27, 2015
Key facts
- NPI
- 1962400630
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pulmonary Disease Physician 207RP1001X
- License
- 25147 (CT)
- Practice address
- 112 Mansfield Ave
Pulmonary Dept., Hatch Wing
Willimantic, CT 06226-2041 - Phone
- (860) 456-7279
- Fax
- (860) 450-0269
- NPI assigned
- Jul 7, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090513000147 | CT | Practitioner - Pulmonary Disease |
3870642333 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25147 | CT | MD | Pulmonary Disease Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hartford Healthcare Medical Group Specialists LLC | Current |
Accepting new patients | |
| Windham Community Memorial Hospital, Inc. | Current |
Accepting new patients | |
| Hartford Healthcare Medical Group, Inc | Current |
Accepting new patients | |
| Hartford Healthcare Medical Group Specialists, PLLC | Current |
Accepting new patients | |
| Hartford Physician Services PC | Pulmonary Disease | Past | Accepting new patients |
Locations
326 Washington St
Norwich, CT 06360
Phone (860) 701-0140
55 Meriden Ave
Ste 1D
Southington, CT 06489
Phone (860) 276-5144
1244 Storrs Rd
Storrs Mansfield, CT 06268
Phone (860) 724-2579
1290 Silas Deane Hwy
Wethersfield, CT 06109
Phone (860) 972-6977
90 Quarry St
Willimantic, CT 06226
Phone (860) 456-2847
112 Mansfield Ave
Willimantic, CT 06226
Phone (830) 423-6410
1060 Day Hill Rd
Windsor, CT 06095
Phone (860) 683-2690
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pulmonary Disease Physician | 207RP1001X | 25147 | CT | Yes |
Addresses
Primary practice location
112 Mansfield Ave
Pulmonary Dept., Hatch Wing
Willimantic, CT 06226-2041
Mailing address
112 Mansfield Ave
Pulmonary Dept., Hatch Wing
Willimantic, CT 06226-2041
Phone (860) 456-7279
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001251479 | Medicaid | CT | |
| 1962400630 | Other | CT | NPI |
Other providers in Willimantic, CT
- Angela M Brown
- Mark Brown
- Janice Shopland Bryant
- Sarah E Bullard
- Anna M Bunch
- Taylor Burgos
- Erica K Byrd
- Miguel Caldera
- Robert Pierce Campagnone
- Jennifer L Capstick
All providers in Willimantic, CT · Pulmonary Disease Physician in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 27, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.