Provider Demographics
NPI:1730159963
Name:BRUMMER, CHARLES K (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:K
Last Name:BRUMMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:94 KING ST
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3284
Mailing Address - Country:US
Mailing Address - Phone:413-585-8880
Mailing Address - Fax:413-585-8879
Practice Address - Street 1:94 KING ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3284
Practice Address - Country:US
Practice Address - Phone:413-585-8880
Practice Address - Fax:413-585-8879
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA052204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ02865OtherBLUE CROSS AND BLUE SHIEL
MA771181OtherTUFTS HEALTH PLAN
MAA56856Medicare UPIN
MAJ02865OtherBLUE CROSS AND BLUE SHIEL