Provider Demographics
NPI:1427024330
Name:BUMGARDNER, JAMES LARSON (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:LARSON
Last Name:BUMGARDNER
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 1:711 LAWN AVE
Mailing Address - Street 2:BLDG 3
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-1575
Mailing Address - Country:US
Mailing Address - Phone:215-257-3700
Mailing Address - Fax:215-257-0360
Practice Address - Street 1:711 LAWN AVE
Practice Address - Street 2:BLDG 3
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1575
Practice Address - Country:US
Practice Address - Phone:215-257-3700
Practice Address - Fax:215-257-0360
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022204E207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0913966Medicaid
004833E3TMedicare ID - Type Unspecified
B30280Medicare UPIN