MEDICARE: DR. JEANNE A LUMADUE MD, PHD

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
1	207ZB0001X	Blood Banking & Transfusion Medicine Physician	MD425020	PA
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	MD425020	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	50059459	OTHER	PA	CAPITAL BLUE CROSS
2	91516	OTHER	PA	GEISINGER HEALTH PLAN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	LU1685791	OTHER	PA	HIGHMARK BLUE SHIELD

General Provider Information

NPI Number	:	1376525055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEANNE A LUMADUE MD, PHD

Provider Business Mailing Address
First Line	:	1850 E PARK AVE
Second Line	:	SUITE 205
City	:	STATE COLLEGE
State	:	PA
Zip	:	16803-6706
Country	:	US
Telephone Number	:	814-234-7800
Fax Number	:	814-235-1133

Provider Business Practice Location Address
First Line	:	CENTRE MEDICAL AND SURGICAL ASSOCIATES, P.C.
Second Line	:	1850 EAST PARK AVENUE, SUITE 205
City	:	STATE COLLEGE
State	:	PA
Zip	:	16803-6706
Country	:	US
Telephone Number	:	814-234-7800
Fax Number	:	814-235-1133

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	03/17/2011

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