Provider Demographics
NPI:1093724510
Name:BLOMAIN, ERIC W (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:W
Last Name:BLOMAIN
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 1:1222 MARION ST
Mailing Address - Street 2:
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18509-2458
Mailing Address - Country:US
Mailing Address - Phone:570-347-1712
Mailing Address - Fax:570-344-4835
Practice Address - Street 1:1222 MARION ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18509-2458
Practice Address - Country:US
Practice Address - Phone:570-347-1712
Practice Address - Fax:570-344-4835
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD017502E208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE63285Medicare UPIN
PA031415Medicare ID - Type Unspecified