Provider Demographics
NPI:1558453373
Name:BLUMENTHAL, BETH ALLISON (MD)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ALLISON
Last Name:BLUMENTHAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1710
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-7710
Mailing Address - Country:US
Mailing Address - Phone:856-770-0504
Mailing Address - Fax:856-770-0395
Practice Address - Street 1:100 CARNIE BLVD
Practice Address - Street 2:SUITE A-4
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4512
Practice Address - Country:US
Practice Address - Phone:856-751-0123
Practice Address - Fax:856-751-5650
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD4288482085R0202X
NJ25MA081637002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2803201000OtherAMERIHEALTH PPO
3186189OtherAETNA
PAMD428848OtherLICENSE
BL1933182OtherHIGHMARK PA BLUE SHIELD
BL1933182OtherPREMIER BLUE
1396272OtherUNITED HEALTHCARE
NJ25MA08163700OtherLICENSE
A3738029OtherOXFORD HEALTH
600030095OtherHORIZON NJ HEALTH
NJ121746Medicaid
5748513OtherFIRST HEALTH
P00400626OtherRAILROAD MEDICARE
11648376OtherCAQH
2803201000OtherAMERIHEALTH HMO
5748513OtherCOVENTRY
600030095OtherHORIZON NJ HEALTH
BL1933182OtherPREMIER BLUE