1669420675 NPI number — LOUIS C BLAUM MD

Table of content: LOUIS C BLAUM MD (NPI 1669420675)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669420675 NPI number — LOUIS C BLAUM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLAUM
Provider First Name:
LOUIS
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669420675
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 N ACADEMY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17822-4903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-271-6144
Provider Business Mailing Address Fax Number:
570-271-6578

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 E MOUNTAIN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILKES BARRE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18711-0027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-808-2340
Provider Business Practice Location Address Fax Number:
570-808-7904
Provider Enumeration Date:
05/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  MD014604E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 158004 . This is a "HEALTH AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 231603 . This is a "HEALTH AMERICA DBC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: C29082 . This is a "STERLING OPTION 1" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 26465 . This is a "GEISINGER HEALTH PL;AN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 814561 . This is a "FIRST PRIORITY HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2793633 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0007544110003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 346793 . This is a "AETNA DBC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 817312 . This is a "FIRST PRIORITY DBC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: BL074789 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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