Provider Demographics
NPI:1124263843
Name:BLUM, AUDRA H (MD)
Entity type:Individual
Prefix:DR
First Name:AUDRA
Middle Name:H
Last Name:BLUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AUDRA
Other - Middle Name:L
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2041 GEORGIA AVE NW
Mailing Address - Street 2:TOWERS BUILDING 1700-C
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20060-0001
Mailing Address - Country:US
Mailing Address - Phone:202-865-4164
Mailing Address - Fax:
Practice Address - Street 1:2041 GEORGIA AVE NW
Practice Address - Street 2:TOWERS BUILDING 1700-C
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20060-0001
Practice Address - Country:US
Practice Address - Phone:202-865-4164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98726207V00000X
DCMD040129207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology