Provider Demographics
NPI: | 1205838406 |
---|---|
Name: | BLAM, OREN GIL (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | OREN |
Middle Name: | GIL |
Last Name: | BLAM |
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: | 910 FREDERICK RD |
Mailing Address - Street 2: | |
Mailing Address - City: | CATONSVILLE |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 21228-4516 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 410-644-1880 |
Mailing Address - Fax: | 410-646-3623 |
Practice Address - Street 1: | 910 FREDERICK RD |
Practice Address - Street 2: | |
Practice Address - City: | CATONSVILLE |
Practice Address - State: | MD |
Practice Address - Zip Code: | 21228-4516 |
Practice Address - Country: | US |
Practice Address - Phone: | 410-644-1880 |
Practice Address - Fax: | 410-646-3623 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-06-01 |
Last Update Date: | 2022-04-04 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MD | D0060243 | 207X00000X |
MD | D60243 | 207XS0117X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207XS0117X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MD | 402742600 | Medicaid | |
H88831 | Medicare UPIN | ||
MD | 402742600 | Medicaid |