Provider Demographics
NPI:1184624850
Name:BLUMENKOPF, BENNETT (MD)
Entity type:Individual
Prefix:DR
First Name:BENNETT
Middle Name:
Last Name:BLUMENKOPF
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 1:420 E NORTH AVE
Mailing Address - Street 2:SUITE 302 AGH NEUROSURGERY
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4746
Mailing Address - Country:US
Mailing Address - Phone:412-359-6200
Mailing Address - Fax:412-359-6617
Practice Address - Street 1:420 E NORTH AVE
Practice Address - Street 2:SUITE 302 AGH NEUROSURGERY
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4746
Practice Address - Country:US
Practice Address - Phone:412-359-6200
Practice Address - Fax:412-359-6617
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD426898207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810006248Medicaid
OH2586803Medicaid
PA0010437730002Medicaid
WV3810006248Medicaid
PA093338N79Medicare PIN