Basic Information
| Provider Information | |||||||||
| NPI: | 1245207315 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLUMER | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6035 FAIRVIEW RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282103256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042953000 | ||||||||
| FaxNumber: | 7048388494 | ||||||||
| Practice Location | |||||||||
| Address1: | 6035 FAIRVIEW RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282103256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042953000 | ||||||||
| FaxNumber: | 7048388494 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2006 | ||||||||
| LastUpdateDate: | 03/31/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 35841 | NC | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 11317 | 01 | NC | DOCTORS HEALTH PLAN | OTHER | 141024 | 01 | COVENTRY HEALTHCARE HMO | OTHER | 16393 | 01 | NC | BCBS | OTHER | 9466 | 01 | PARTNERS SELECT CARE | OTHER | N35841 | 05 | SC | MEDICAID | 01146087 | 01 | SC | AMERIGROUP COMMUNITY CARE | OTHER | 20087248 | 01 | SC | SELECT HEALTH OF SC/FIRST CHOICE | OTHER | 4570715 | 01 | AETNA | OTHER | 276567 | 01 | MAMSI | OTHER | 8916393 | 05 | NC | MEDICAID | 44672 | 01 | NC | MEDCOST | OTHER | 26674 | 01 | NC | WELLPATH | OTHER | 771567 | 01 | SC | WELLCARE | OTHER | 5703439003 | 01 | NC | CIGNA | OTHER |