Provider Demographics
NPI:1689694960
Name:BLUM, NATHAN J (MD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:J
Last Name:BLUM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:100 E PENN SQ
Mailing Address - Street 2:9TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-3323
Mailing Address - Country:US
Mailing Address - Phone:267-425-9234
Mailing Address - Fax:267-425-9299
Practice Address - Street 1:3550 MARKET ST FL 3
Practice Address - Street 2:CHILDREN'S HOSPITAL OF PHILADELPHIA - CHILD DEVELOPMENT
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3365
Practice Address - Country:US
Practice Address - Phone:267-425-5200
Practice Address - Fax:267-426-0975
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2013-04-15
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Provider Licenses
StateLicense IDTaxonomies
PAMD042057L208000000X, 2080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001464739Medicaid
NJ6183701Medicaid
NJ6183701Medicaid
PA001464739Medicaid