Basic Information
Provider Information
NPI: 1437190261
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BUMP
FirstName: GREGORY
MiddleName: MATTHEW
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3459 5TH AVE
Address2: MUH 9 SOUTH
City: PITTSBURGH
State: PA
PostalCode: 152133236
CountryCode: US
TelephoneNumber: 4126924888
FaxNumber: 4126474050
Practice Location
Address1: 3459 FIFTH AVE
Address2: MVH 9-SOUTH
City: PITTSBURGH
State: PA
PostalCode: 15213
CountryCode: US
TelephoneNumber: 4126924888
FaxNumber: 4126924825
Other Information
ProviderEnumerationDate: 06/10/2006
LastUpdateDate: 08/01/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/01/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XMD428684PAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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