Healthcare Provider Details

I. General information

NPI: 1245279165
Provider Name (Legal Business Name): CLAYSBURG MEDICAL ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 02/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 WARD DRIVE
CLAYSBURG PA
16625-9742
US

IV. Provider business mailing address

365 WARD DRIVE PO BOX 267
CLAYSBURG PA
16625-9742
US

V. Phone/Fax

Practice location:
  • Phone: 814-239-2211
  • Fax: 814-239-8116
Mailing address:
  • Phone: 814-239-2211
  • Fax: 814-239-8116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DONALD WILLIAM BULGER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 814-239-2211