MEDICARE: ELIZABETH MUMPER MD

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	208000000X	Pediatrics Physician	0101036534	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	10387072	OTHER	VA	CAQH
3	192224	OTHER	VA	ANTHEM

General Provider Information

NPI Number	:	1871557959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH MUMPER MD

Provider Business Mailing Address
First Line	:	2015 TATE SPRINGS RD
Second Line	:	SUITE 2, LOWER LEVEL
City	:	LYNCHBURG
State	:	VA
Zip	:	24501-1111
Country	:	US
Telephone Number	:	434-528-9075
Fax Number	:	434-528-9078

Provider Business Practice Location Address
First Line	:	2015 TATE SPRINGS RD
Second Line	:	SUITE 2, LOWER LEVEL
City	:	LYNCHBURG
State	:	VA
Zip	:	24501-1111
Country	:	US
Telephone Number	:	434-528-9075
Fax Number	:	434-528-9078

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

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	07/08/2007

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