Provider Demographics
NPI:1598788051
Name:BLUMIN, DAVID HARRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:HARRIS
Last Name:BLUMIN
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:PO BOX 216
Mailing Address - Street 2:
Mailing Address - City:EAST BOOTHBAY
Mailing Address - State:ME
Mailing Address - Zip Code:04544-0216
Mailing Address - Country:US
Mailing Address - Phone:207-687-3103
Mailing Address - Fax:
Practice Address - Street 1:1990 N CALIFORNIA BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-3742
Practice Address - Country:US
Practice Address - Phone:925-225-5837
Practice Address - Fax:925-482-2834
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME012008207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C66192Medicare UPIN
CABD603YMedicare PIN