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NPI Code Detail

MEDICARE: DAVID RICHARD BLUM MA

MEDICARE: DAVID RICHARD BLUM MA
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
1103T00000XPsychologist464WV
2103TC0700XClinical Psychologist464WV
3103TA0400XAddiction (Substance Use Disorder) Psychologist464WV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1001719066OTHERWVBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1285794644
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID RICHARD BLUM MA
Provider Business Mailing Address
First Line : 501 COLLIERS WAY
Second Line :
City : WEIRTON
State : WV
Zip : 26062-5003
Country : US
Telephone Number : 304-723-5440
Fax Number :
Provider Business Practice Location Address
First Line : 501 COLLIERS WAY
Second Line :
City : WEIRTON
State : WV
Zip : 26062-5003
Country : US
Telephone Number : 304-723-5440
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2006
Last Update Date : 01/25/2012

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Directions to “ DAVID RICHARD BLUM MA” Practice Location

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