Provider Demographics
NPI:1649296674
Name:HAROLD L. BLUMENTHAL, M.D., INC.
Entity type:Organization
Organization Name:HAROLD L. BLUMENTHAL, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VPRES
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUMENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-464-7200
Mailing Address - Street 1:3619 PARK EAST DR
Mailing Address - Street 2:SUITE 209
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4330
Mailing Address - Country:US
Mailing Address - Phone:216-464-7200
Mailing Address - Fax:216-464-0020
Practice Address - Street 1:3619 PARK EAST DR
Practice Address - Street 2:SUITE 209
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4330
Practice Address - Country:US
Practice Address - Phone:216-464-7200
Practice Address - Fax:216-464-0020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3502462613207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0076680Medicaid
OH0076680Medicaid
OHLI9930011Medicare PIN