Provider Demographics
NPI:1619958121
Name:MUMMA, PAUL D (DO)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:D
Last Name:MUMMA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1821
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43702-1821
Mailing Address - Country:US
Mailing Address - Phone:740-455-3304
Mailing Address - Fax:740-455-3686
Practice Address - Street 1:721 CHINA ST
Practice Address - Street 2:
Practice Address - City:CROOKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43731-1123
Practice Address - Country:US
Practice Address - Phone:740-697-0173
Practice Address - Fax:740-982-5551
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004248M207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0645136Medicaid
OHMU0591942Medicare ID - Type Unspecified
OH0645136Medicaid