Provider Demographics
NPI:1477522845
Name:BUMGARTNER, JAMES L (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
Last Name:BUMGARTNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:125 DOUGHTY ST
Mailing Address - Street 2:SUITE 460
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-5736
Mailing Address - Country:US
Mailing Address - Phone:843-723-0202
Mailing Address - Fax:843-723-1052
Practice Address - Street 1:125 DOUGHTY ST
Practice Address - Street 2:SUITE 460
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-5736
Practice Address - Country:US
Practice Address - Phone:843-723-0202
Practice Address - Fax:843-723-1052
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC88282084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC088283Medicaid
SCB92318Medicare UPIN
SC3124Medicare PIN