Healthcare Provider Details

I. General information

NPI: 1962597526
Provider Name (Legal Business Name): LIANA BUMBREY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 FRANKLIN SQUARE
BALTIMORE MD
21218
US

IV. Provider business mailing address

1000 RIVER ROAD STE 100
CONSHOHOCKEN PA
19428
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-9696
  • Fax:
Mailing address:
  • Phone: 800-355-3818
  • Fax: 610-834-2862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberC03146
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: