Provider Demographics
NPI:1851337471
Name:BLOUNT, HOWARD PAUL III (MD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:PAUL
Last Name:BLOUNT
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:HOWARD
Other - Middle Name:P
Other - Last Name:BLOUNT
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1435 EBENEZER RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732
Practice Address - Country:US
Practice Address - Phone:803-328-3828
Practice Address - Fax:803-328-3879
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29340207Q00000X
SC83289207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN080152465OtherRR MEDICARE
TN3815083Medicaid
TN3717545Medicare ID - Type UnspecifiedLEGACY GROUP
TN3815084Medicare ID - Type UnspecifiedLEGACY PIN
TN080152465OtherRR MEDICARE