1376525055 NPI number — DR. JEANNE A LUMADUE MD, PHD

Table of content: DR. JEANNE A LUMADUE MD, PHD (NPI 1376525055)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376525055 NPI number — DR. JEANNE A LUMADUE MD, PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUMADUE
Provider First Name:
JEANNE
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376525055
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CENTRE MEDICAL AND SURGICAL ASSOCIATES, P.C.
Provider Second Line Business Practice Location Address:
1850 EAST PARK AVENUE, SUITE 205
Provider Business Practice Location Address City Name:
STATE COLLEGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16803-6706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-234-7800
Provider Business Practice Location Address Fax Number:
814-235-1133
Provider Enumeration Date:
11/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZB0001X , with the licence number:  MD425020 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0102X , with the licence number: MD425020 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 50059459 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 91516 . This is a "GEISINGER HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1012133660002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: LU1685791 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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