Provider Demographics
NPI:1649332974
Name:BRUMBAUGH, MARTHA JO (MD)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:JO
Last Name:BRUMBAUGH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 SECOND AVE
Mailing Address - Street 2:
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1410
Mailing Address - Country:US
Mailing Address - Phone:856-547-4734
Mailing Address - Fax:
Practice Address - Street 1:436 SECOND AVE
Practice Address - Street 2:
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1410
Practice Address - Country:US
Practice Address - Phone:856-547-4734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03647100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
J0212OtherHORIZON
C55643Medicare UPIN
J0212OtherHORIZON