Provider Demographics
NPI:1649295726
Name:BUMGARDNER, RICHARD CATOE (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:CATOE
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 1:27443 ANDREW JACKSON HWY E
Mailing Address - Street 2:
Mailing Address - City:DELCO
Mailing Address - State:NC
Mailing Address - Zip Code:28436-8822
Mailing Address - Country:US
Mailing Address - Phone:910-655-1980
Mailing Address - Fax:910-655-1981
Practice Address - Street 1:27443 ANDREW JACKSON HWY E
Practice Address - Street 2:
Practice Address - City:DELCO
Practice Address - State:NC
Practice Address - Zip Code:28436-8822
Practice Address - Country:US
Practice Address - Phone:910-655-1980
Practice Address - Fax:910-655-1981
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000190207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89126TYMedicaid
H13758Medicare UPIN
NC2280289BMedicare PIN