Provider Demographics
NPI:1306057427
Name:HOWARD BRUMBAUGH MD PC
Entity type:Organization
Organization Name:HOWARD BRUMBAUGH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRUMBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-575-1147
Mailing Address - Street 1:10293 N MERIDIAN ST
Mailing Address - Street 2:SUITE 325
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46290-1123
Mailing Address - Country:US
Mailing Address - Phone:317-575-1147
Mailing Address - Fax:317-574-4767
Practice Address - Street 1:10293 N MERIDIAN ST
Practice Address - Street 2:SUITE 325
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46290-1123
Practice Address - Country:US
Practice Address - Phone:317-575-1147
Practice Address - Fax:317-574-4767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027008A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100121720Medicaid
180016640OtherRAILROAD MEDICARE
IN279600Medicare Oscar/Certification
IN279600Medicare PIN