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General NPI Number Information
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NPI Number | 1750796793
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Entity Type | Individual
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Provider Name | VERONIKA SAFRONOVNA BUMGARDNER PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/29/2014
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Last Update Date | 05/23/2019
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Provider Practice Location Address
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Address Line | 7915 LAKE MANASSAS DR SUITE 205
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City | GAINESVILLE
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State | VA
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Zip | 20155-3258
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Country | US
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Telephone | 571-261-3529
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Fax | 703-753-5613
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Provider Business Mailing Address
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Address Line | PO BOX 21975
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City | BELFAST
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State | ME
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Zip | 04915-4116
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Country | US
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Telephone | 540-321-4281
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Fax | 540-321-4282
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110004522
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License Number State | VA
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