Provider Demographics
NPI:1073257994
Name:UMBARGER, JAKE HARRISON (PA)
Entity Type:Individual
Prefix:
First Name:JAKE
Middle Name:HARRISON
Last Name:UMBARGER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 BRADSHAW RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-8018
Mailing Address - Country:US
Mailing Address - Phone:540-309-0307
Mailing Address - Fax:
Practice Address - Street 1:4900 BRADSHAW RD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-8018
Practice Address - Country:US
Practice Address - Phone:540-309-0307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant