Provider Demographics
NPI:1306007455
Name:BLUM, LIRAN
Entity Type:Individual
Prefix:DR
First Name:LIRAN
Middle Name:
Last Name:BLUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 PINE ST STE 304
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-6951
Mailing Address - Country:US
Mailing Address - Phone:860-582-3235
Mailing Address - Fax:860-583-1399
Practice Address - Street 1:22 PINE ST STE 304
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-6951
Practice Address - Country:US
Practice Address - Phone:860-582-3235
Practice Address - Fax:833-516-0583
Is Sole Proprietor?:No
Enumeration Date:2008-06-21
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT54176207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease