Healthcare Provider Details

I. General information

NPI: 1851619456
Provider Name (Legal Business Name): JOSEPH MCNEILL BUMGARNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2010
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 BLUE RIDGE RD STE 400
RALEIGH NC
27607
US

IV. Provider business mailing address

2800 BLUE RIDGE RD STE 400
RALEIGH NC
27607-6477
US

V. Phone/Fax

Practice location:
  • Phone: 919-787-5380
  • Fax: 919-787-3415
Mailing address:
  • Phone: 919-787-5380
  • Fax: 919-787-3415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number2013-00376
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2013-00376
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: