Provider Demographics
NPI:1679520928
Name:BLUM, DAVID STEVEN (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:STEVEN
Last Name:BLUM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4425 FITCH AVENUE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-3927
Mailing Address - Country:US
Mailing Address - Phone:410-682-3000
Mailing Address - Fax:410-682-6890
Practice Address - Street 1:4425 FITCH AVENUE
Practice Address - Street 2:SUITE 120
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-3927
Practice Address - Country:US
Practice Address - Phone:410-682-3000
Practice Address - Fax:410-682-6890
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTAO857152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDXZ72DSOtherCAREFIRST BCBS
MD382-00-8400Medicaid
MD522253219OtherADVANTICA
MDXZ72DSOtherCAREFIRST BCBS
MD522253219OtherADVANTICA