Provider Demographics
NPI:1669420675
Name:BLAUM, LOUIS C (MD)
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:C
Last Name:BLAUM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:1000 E MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18711-0027
Practice Address - Country:US
Practice Address - Phone:570-808-2340
Practice Address - Fax:570-808-7904
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2020-08-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD014604E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA158004OtherHEALTH AMERICA
PA231603OtherHEALTH AMERICA DBC
PAC29082OtherSTERLING OPTION 1
PA26465OtherGEISINGER HEALTH PL;AN
PA814561OtherFIRST PRIORITY HEALTH
PA2793633OtherAETNA
PA0007544110003Medicaid
PA346793OtherAETNA DBC
PA817312OtherFIRST PRIORITY DBC
PABL074789OtherHIGHMARK BLUE SHIELD
PA074789QERMedicare PIN
PA2793633OtherAETNA
PAC29082OtherSTERLING OPTION 1
PA346793OtherAETNA DBC