MEDICARE: DR. CRAIG ASHLEY 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	208600000X	Surgery Physician	LL28156	SC
2	2086S0122X	Plastic and Reconstructive Surgery Physician	28156	SC

General Provider Information

NPI Number	:	1285718866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG ASHLEY BLUM M.D.

Provider Business Mailing Address
First Line	:	4993 OHEAR AVE APT 4105
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29405-4999
Country	:	US
Telephone Number	:	843-818-8747
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 W 8TH NORTH ST STE B
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29483-6656
Country	:	US
Telephone Number	:	843-471-1135
Fax Number	:

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	03/11/2019

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