Provider Demographics
NPI:1386197283
Name:DR. DOROTHY THOMAS-BLUME D.O.
Entity Type:Organization
Organization Name:DR. DOROTHY THOMAS-BLUME D.O.
Other - Org Name:ADVANCE WOUND CARE SPECIALIST, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS-BLUME
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:202-299-6536
Mailing Address - Street 1:1050 JOHNNIE DODDS BLVD
Mailing Address - Street 2:#2278
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3684
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:105 BURTON AVE
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8118
Practice Address - Country:US
Practice Address - Phone:843-832-5379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1635207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty