MEDICARE: RONALD I BLUM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	008285	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609824747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD I BLUM M.D.

Provider Business Mailing Address
First Line	:	PO BOX 385
Second Line	:
City	:	PATTEN
State	:	ME
Zip	:	04765-0385
Country	:	US
Telephone Number	:	207-528-2067
Fax Number	:	207-528-2257

Provider Business Practice Location Address
First Line	:	17 FOUNDERS STREET
Second Line	:
City	:	PATTEN
State	:	ME
Zip	:	04765
Country	:	US
Telephone Number	:	207-528-2067
Fax Number	:	207-528-2257

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	06/05/2014

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