Provider Demographics
NPI:1376525055
Name:LUMADUE, JEANNE A (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:A
Last Name:LUMADUE
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 E PARK AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-6706
Mailing Address - Country:US
Mailing Address - Phone:814-234-7800
Mailing Address - Fax:814-235-1133
Practice Address - Street 1:CENTRE MEDICAL AND SURGICAL ASSOCIATES, P.C.
Practice Address - Street 2:1850 EAST PARK AVENUE, SUITE 205
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-6706
Practice Address - Country:US
Practice Address - Phone:814-234-7800
Practice Address - Fax:814-235-1133
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD425020207ZB0001X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50059459OtherCAPITAL BLUE CROSS
PA91516OtherGEISINGER HEALTH PLAN
PA1012133660002Medicaid
PALU1685791OtherHIGHMARK BLUE SHIELD
PA1012133660002Medicaid