Provider Demographics
NPI:1871557959
Name:MUMPER, ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MUMPER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 TATE SPRINGS RD
Mailing Address - Street 2:SUITE 2, LOWER LEVEL
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-1111
Mailing Address - Country:US
Mailing Address - Phone:434-528-9075
Mailing Address - Fax:434-528-9078
Practice Address - Street 1:2015 TATE SPRINGS RD
Practice Address - Street 2:SUITE 2, LOWER LEVEL
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1111
Practice Address - Country:US
Practice Address - Phone:434-528-9075
Practice Address - Fax:434-528-9078
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101036534208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6701361Medicaid
VA10387072OtherCAQH
VA192224OtherANTHEM
VAD80437Medicare UPIN