Provider Demographics
NPI:1861700643
Name:BUMEDER, KEITH (PA-C)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:BUMEDER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-721-8789
Mailing Address - Fax:717-715-1360
Practice Address - Street 1:207 W FULTON ST
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-1902
Practice Address - Country:US
Practice Address - Phone:717-721-8789
Practice Address - Fax:717-715-1360
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA054613363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1032012750001Medicaid