Provider Demographics
NPI:1871544189
Name:BUMGARDNER, GINNY L (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:GINNY
Middle Name:L
Last Name:BUMGARDNER
Suffix:
Gender:
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-6724
Mailing Address - Fax:614-293-6720
Practice Address - Street 1:300 W 10TH AVE FL 11
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1280
Practice Address - Country:US
Practice Address - Phone:614-293-6724
Practice Address - Fax:614-293-6710
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35065669204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0934332Medicaid
OH0748713Medicare PIN
F43717Medicare UPIN