Provider Demographics
NPI:1407947823
Name:BLUMENTHAL, LAURENCE STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:LAURENCE
Middle Name:STEVEN
Last Name:BLUMENTHAL
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 1:30 BEE ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-5847
Mailing Address - Country:US
Mailing Address - Phone:843-792-3664
Mailing Address - Fax:843-792-2318
Practice Address - Street 1:30 BEE ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-5847
Practice Address - Country:US
Practice Address - Phone:843-792-3664
Practice Address - Fax:843-792-2318
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13074207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine