Basic Information
| Provider Information | |||||||||
| NPI: | 1609870054 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRUBAKER | ||||||||
| FirstName: | HERMAN | ||||||||
| MiddleName: | WALLACE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 785 5TH AVE | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172639555 | ||||||||
| FaxNumber: | 7172174218 | ||||||||
| Practice Location | |||||||||
| Address1: | 12 ST PAUL DR STE 101 | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172011035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172176760 | ||||||||
| FaxNumber: | 7172176912 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2005 | ||||||||
| LastUpdateDate: | 06/18/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD028694E | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 080086589 | 01 | PA | RAILROAD MEDICARE | OTHER | 4397945 | 01 | PA | AETNA NON-HMO | OTHER | 867633 | 01 | PA | MEDICARE GROUP # | OTHER | 25-1716306 | 01 | PA | MULTIPLAN/PHCS | OTHER | 426224 | 01 | PA | HEALTH AMERICA | OTHER | P006020 | 01 | PA | GATEWAY | OTHER | 1806901 | 01 | PA | CAPITAL BLUECROSS | OTHER | 25-1716306 | 01 | PA | INFORMED | OTHER | 25-1716306 | 01 | PA | DEVON | OTHER | 25-1716306 | 01 | PA | SOUTH CENTRAL PREFERRED | OTHER | AB1485805 | 01 | PA | DEA | OTHER | 000908788 | 05 | PA | MEDICAID | 247728 | 01 | PA | MAMSI | OTHER | 122715 | 01 | PA | UNISON | OTHER | 666058 | 01 | PA | FIRST HEALTH | OTHER | MD028694E | 01 | PA | LICENSE | OTHER | 120420409 | 01 | PA | DEPT OF LABOR | OTHER | 25-1716306 | 01 | PA | INTERGROUP | OTHER | 25-1716306 | 01 | PA | GREATWEST | OTHER | 842753 | 01 | PA | AETNA HMO | OTHER | BR426736 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER |