Provider Demographics
NPI:1679536775
Name:BUNDY, NICOLE C (MD)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:C
Last Name:BUNDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:C
Other - Last Name:RABIDOU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:700 ACKERMAN RD
Mailing Address - Street 2:SUITE 385
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-947-3700
Mailing Address - Fax:614-947-3771
Practice Address - Street 1:3900 STONERIDGE LN
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-2009
Practice Address - Country:US
Practice Address - Phone:614-293-0080
Practice Address - Fax:614-293-0077
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35095711207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA327690465AMedicaid
GA327690465AMedicaid
I32997Medicare UPIN