Provider Demographics
NPI:1689623324
Name:BLUM, HAYWOOD (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:HAYWOOD
Middle Name:
Last Name:BLUM
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 TAYLOR DR
Mailing Address - Street 2:
Mailing Address - City:CENTER VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18034-8709
Mailing Address - Country:US
Mailing Address - Phone:610-282-4353
Mailing Address - Fax:
Practice Address - Street 1:GOOD SAMARITAN REGIONAL MEDICAL CENTER, EMERGENCY DEPT
Practice Address - Street 2:700 E NORWEGIAN ST
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901
Practice Address - Country:US
Practice Address - Phone:570-621-4656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027475E207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012931210014Medicaid
PAF34227Medicare UPIN