Provider Demographics
NPI:1871583716
Name:BRUMAGE, MICHAEL ROSS (MD, MPH, FACP)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ROSS
Last Name:BRUMAGE
Suffix:
Gender:M
Credentials:MD, MPH, FACP
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Mailing Address - Street 1:104 ALEX LN
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-2952
Mailing Address - Country:US
Mailing Address - Phone:304-734-2040
Mailing Address - Fax:304-734-2047
Practice Address - Street 1:107 KOONTZ AVE
Practice Address - Street 2:
Practice Address - City:CLENDENIN
Practice Address - State:WV
Practice Address - Zip Code:25045-9578
Practice Address - Country:US
Practice Address - Phone:304-548-7272
Practice Address - Fax:304-548-7149
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIMD10162207R00000X, 2083P0901X
WV266022083P0901X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN