Provider Demographics
NPI:1609824747
Name:BLUM, RONALD I (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:I
Last Name:BLUM
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 385
Mailing Address - Street 2:
Mailing Address - City:PATTEN
Mailing Address - State:ME
Mailing Address - Zip Code:04765-0385
Mailing Address - Country:US
Mailing Address - Phone:207-528-2067
Mailing Address - Fax:207-528-2257
Practice Address - Street 1:17 FOUNDERS STREET
Practice Address - Street 2:
Practice Address - City:PATTEN
Practice Address - State:ME
Practice Address - Zip Code:04765
Practice Address - Country:US
Practice Address - Phone:207-528-2067
Practice Address - Fax:207-528-2257
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME008285174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME112640000Medicaid
MED03636Medicare UPIN
ME112640000Medicaid