Provider Demographics
NPI:1588745939
Name:BLAUM, CAROLINE S (MD, MS)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:S
Last Name:BLAUM
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:550 1ST AVE
Mailing Address - Street 2:BCD612
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6402
Mailing Address - Country:US
Mailing Address - Phone:646-501-2323
Mailing Address - Fax:
Practice Address - Street 1:530 1ST AVE
Practice Address - Street 2:SUITE 7B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6402
Practice Address - Country:US
Practice Address - Phone:212-263-8313
Practice Address - Fax:212-263-8995
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301043629207R00000X, 207RG0300X
NY267464-1207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2746670Medicaid
MI0H1761355Medicare PIN
MIB48204Medicare UPIN