Provider Demographics
NPI:1013016138
Name:BLUBAUGH, MICHAEL L (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:BLUBAUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488-2766
Mailing Address - Country:US
Mailing Address - Phone:843-549-4335
Mailing Address - Fax:843-549-6502
Practice Address - Street 1:461 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-2766
Practice Address - Country:US
Practice Address - Phone:843-549-4335
Practice Address - Fax:843-782-3070
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19591207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2719Medicaid
SCGP2719Medicaid
F508747061Medicare ID - Type Unspecified