Provider Demographics
NPI:1780673582
Name:BLUME, STEVEN HARRISON (DPM)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:HARRISON
Last Name:BLUME
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 PEACH TREE RD
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033
Mailing Address - Country:US
Mailing Address - Phone:860-633-4032
Mailing Address - Fax:860-633-3063
Practice Address - Street 1:129 PEACH TREE RD
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-3647
Practice Address - Country:US
Practice Address - Phone:860-633-4032
Practice Address - Fax:860-633-3063
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-14
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000420213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004082020Medicaid