Provider Demographics
NPI:1083701080
Name:SUMRALL, BLAIR STOWE (MD)
Entity Type:Individual
Prefix:DR
First Name:BLAIR
Middle Name:STOWE
Last Name:SUMRALL
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 1:2125 SAINT LUKES DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-2038
Mailing Address - Country:US
Mailing Address - Phone:843-817-3103
Mailing Address - Fax:
Practice Address - Street 1:2125 SAINT LUKES DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-2038
Practice Address - Country:US
Practice Address - Phone:843-817-3103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27033207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine