Provider Demographics
NPI:1831390848
Name:BLUMNER, HARRY NORMAN III (PSD)
Entity type:Individual
Prefix:DR
First Name:HARRY
Middle Name:NORMAN
Last Name:BLUMNER
Suffix:III
Gender:M
Credentials:PSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 SPORTSMAN RD
Mailing Address - Street 2:
Mailing Address - City:WERNERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19565-9434
Mailing Address - Country:US
Mailing Address - Phone:610-678-3411
Mailing Address - Fax:
Practice Address - Street 1:300 SPORTSMAN RD
Practice Address - Street 2:
Practice Address - City:WERNERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19565-9434
Practice Address - Country:US
Practice Address - Phone:610-678-3411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005954L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA762309Medicare ID - Type Unspecified