Basic Information
| Provider Information | |||||||||
| NPI: | 1588733109 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUSH | ||||||||
| FirstName: | ZACHARY | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3048 ALBERENE CHURCH LN | ||||||||
| Address2: | |||||||||
| City: | ESMONT | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229371516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4345667628 | ||||||||
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| Practice Location | |||||||||
| Address1: | 415 RAY C HUNT DR | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229032980 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349241825 | ||||||||
| FaxNumber: | 4349249616 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2006 | ||||||||
| LastUpdateDate: | 05/13/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0101239018 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RE0101X | 0101239018 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 1588733109 | 05 | VA | MEDICAID |