Provider Demographics
NPI:1407629199
Name:BLUM, MADISON (PA-C)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:BLUM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 E MARSHALL ST STE 303
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-4454
Mailing Address - Country:US
Mailing Address - Phone:610-738-2690
Mailing Address - Fax:
Practice Address - Street 1:600 E MARSHALL ST STE 303
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4454
Practice Address - Country:US
Practice Address - Phone:610-738-2690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA0650822086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery