Provider Demographics
NPI:1699775098
Name:BRUBAKER, CYNTHIA (PAC)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:BRUBAKER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:734 N FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2176
Mailing Address - Country:US
Mailing Address - Phone:717-295-2323
Mailing Address - Fax:717-295-7294
Practice Address - Street 1:734 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2176
Practice Address - Country:US
Practice Address - Phone:717-295-2323
Practice Address - Fax:717-295-7294
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA00083L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA158841OtherMDICARE GROUP NUMBER
PA114966Medicare PIN
PAS52393Medicare UPIN