Healthcare Provider Details

I. General information

NPI: 1255528139
Provider Name (Legal Business Name): ROBERT LINVILLE BUMGARNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 02/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NATIONAL NAVAL MEDICAL CENTER 8901 WISCONSIN AVENUE
BETHESDA MD
20889-5600
US

IV. Provider business mailing address

PO BOX 4077
MERRIFIELD VA
22116-4077
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-5800
  • Fax:
Mailing address:
  • Phone: 703-676-5468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number0101030764
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number4301040859
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: