Provider Demographics
NPI:1518957844
Name:BLUMENTHAL, JEROME B (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:B
Last Name:BLUMENTHAL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:55 WHITCHER ST NE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1155
Mailing Address - Country:US
Mailing Address - Phone:770-422-2004
Mailing Address - Fax:770-422-8465
Practice Address - Street 1:625 CHURCH ST NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1101
Practice Address - Country:US
Practice Address - Phone:770-422-2004
Practice Address - Fax:770-422-8465
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2019-10-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA010104207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine