Provider Demographics
NPI:1407850324
Name:MUMBAUER, STEVEN WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:WAYNE
Last Name:MUMBAUER
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 1:19 GREEN HILLS DRIVE
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:VA
Mailing Address - Zip Code:24482
Mailing Address - Country:US
Mailing Address - Phone:540-949-0118
Mailing Address - Fax:540-932-2059
Practice Address - Street 1:19 GREEN HILLS DRIVE
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:VA
Practice Address - Zip Code:24482-2659
Practice Address - Country:US
Practice Address - Phone:540-949-0118
Practice Address - Fax:540-932-2059
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057329208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10535OtherCIGNA
VA006720285Medicaid
VA245317OtherANTHEM
156885OtherSOUTHERN HEALTH
45636OtherOPTIMA
1084226OtherFIRSTH HEALTH
VA245317OtherANTHEM