Healthcare Provider Details

I. General information

NPI: 1962499731
Provider Name (Legal Business Name): PETER R BUMANIS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 BREMO RD
RICHMOND VA
23226-1907
US

IV. Provider business mailing address

4 LEXINGTON RD
RICHMOND VA
23226-1626
US

V. Phone/Fax

Practice location:
  • Phone: 804-288-6258
  • Fax: 804-282-9921
Mailing address:
  • Phone: 804-562-1408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0102037151
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: