Provider Demographics
NPI:1073585790
Name:BUMBAUGH, JAMES HOWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:HOWARD
Last Name:BUMBAUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20130 ROUTE 19
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-6218
Mailing Address - Country:US
Mailing Address - Phone:724-779-5005
Mailing Address - Fax:
Practice Address - Street 1:20130 ROUTE 19
Practice Address - Street 2:SUITE 1000
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066-6218
Practice Address - Country:US
Practice Address - Phone:724-779-5005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005699L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001302347Medicaid
PA405014PD9Medicare ID - Type Unspecified
PAB41270Medicare UPIN