Provider Demographics
NPI:1235156738
Name:BLUMENSTOCK, EDWARD MARTIN (MD)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:MARTIN
Last Name:BLUMENSTOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:365 HAWTHORNE AVE
Mailing Address - Street 2:STE 301
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3113
Mailing Address - Country:US
Mailing Address - Phone:510-893-1700
Mailing Address - Fax:510-893-0110
Practice Address - Street 1:365 HAWTHORNE AVE
Practice Address - Street 2:STE 301
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3113
Practice Address - Country:US
Practice Address - Phone:510-893-1700
Practice Address - Fax:510-893-0110
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG22905207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G229050Medicaid
CA00G229050Medicaid
00G229050Medicare ID - Type Unspecified