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NPI Code Detail

MEDICARE: DR. CARLA J BRUMBAUGH M.D.

MEDICARE: DR. CARLA J BRUMBAUGH M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician01041267IN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000092606OTHERINANTHEM

General Provider Information

NPI Number : 1144271370
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CARLA J BRUMBAUGH M.D.
Provider Business Mailing Address
First Line : PO BOX 5602
Second Line :
City : FORT WAYNE
State : IN
Zip : 46895-5602
Country : US
Telephone Number : 260-471-9466
Fax Number : 260-484-5919
Provider Business Practice Location Address
First Line : 3707 NEW VISION DR
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-1702
Country : US
Telephone Number : 260-471-9466
Fax Number : 260-484-5919
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2006
Last Update Date : 07/08/2007

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