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General NPI Number Information
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NPI Number | 1336362755
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Entity Type | Organization
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Legal Business Name | PERSONAL CARE PEDS LLC
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 340 N MAIN ST
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City | SOUTHINGTON
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State | CT
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Zip | 06489-2529
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Country | US
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Telephone | 680-628-5767
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Fax |
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Provider Business Mailing Address
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Address Line | 340 N MAIN ST
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City | SOUTHINGTON
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State | CT
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Zip | 06489-2529
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Country | US
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Telephone | 680-628-5767
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. ARTHUR T BLUMER
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Credential | M.D.
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Telephone | 860-628-5767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | 15074
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License Number State | CT
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