Provider Demographics
NPI:1215922687
Name:WEST-BUMP, MAGGIE L (RPAC)
Entity type:Individual
Prefix:
First Name:MAGGIE
Middle Name:L
Last Name:WEST-BUMP
Suffix:
Gender:F
Credentials:RPAC
Other - Prefix:
Other - First Name:MAGGIE
Other - Middle Name:L
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPAC
Mailing Address - Street 1:123 EVERETT RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1407
Mailing Address - Country:US
Mailing Address - Phone:518-701-2000
Mailing Address - Fax:518-701-2020
Practice Address - Street 1:400 PATROON CREEK BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-5013
Practice Address - Country:US
Practice Address - Phone:518-701-2000
Practice Address - Fax:518-701-2020
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008545363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPA1482Medicare PIN