Healthcare Provider Details

I. General information

NPI: 1407850324
Provider Name (Legal Business Name): STEVEN WAYNE MUMBAUER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 07/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 GREEN HILLS DRIVE
VERONA VA
24482-2659
US

IV. Provider business mailing address

19 GREEN HILLS DRIVE
VERONA VA
24482
US

V. Phone/Fax

Practice location:
  • Phone: 540-949-0118
  • Fax: 540-932-2059
Mailing address:
  • Phone: 540-949-0118
  • Fax: 540-932-2059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101057329
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: