Healthcare Provider Details

I. General information

NPI: 1861700643
Provider Name (Legal Business Name): KEITH BUMEDER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 W FULTON ST
EPHRATA PA
17522-1902
US

IV. Provider business mailing address

3421 CONCORD RD
YORK PA
17402-9001
US

V. Phone/Fax

Practice location:
  • Phone: 717-721-8789
  • Fax: 717-715-1360
Mailing address:
  • Phone: 717-721-8789
  • Fax: 717-715-1360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA054613
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: