Provider Demographics
NPI:1245279165
Name:CLAYSBURG MEDICAL ASSOCIATES, INC
Entity type:Organization
Organization Name:CLAYSBURG MEDICAL ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BULGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-239-2211
Mailing Address - Street 1:365 WARD DRIVE
Mailing Address - Street 2:PO BOX 267
Mailing Address - City:CLAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16625-9742
Mailing Address - Country:US
Mailing Address - Phone:814-239-2211
Mailing Address - Fax:814-239-8116
Practice Address - Street 1:365 WARD DRIVE
Practice Address - Street 2:
Practice Address - City:CLAYSBURG
Practice Address - State:PA
Practice Address - Zip Code:16625-9742
Practice Address - Country:US
Practice Address - Phone:814-239-2211
Practice Address - Fax:814-239-8116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA076155OtherHIGHMARK BLUE SHIELD
PA1007787570006Medicaid
PA076155Medicare PIN