Provider Demographics
NPI:1740844372
Name:BLUM, MEGAN ELAINE
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ELAINE
Last Name:BLUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 SILVERMINE RD
Mailing Address - Street 2:
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-4329
Mailing Address - Country:US
Mailing Address - Phone:314-888-5233
Mailing Address - Fax:203-590-8644
Practice Address - Street 1:1123 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4003
Practice Address - Country:US
Practice Address - Phone:314-888-5233
Practice Address - Fax:203-590-8644
Is Sole Proprietor?:No
Enumeration Date:2019-04-29
Last Update Date:2023-01-18
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant