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NPI Code Detail

MEDICARE: DAVID L BLOOM PA

MEDICARE: DAVID L BLOOM PA
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
12085R0202XDiagnostic Radiology PhysicianMD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396738704
Entity Type Code : Organization
Provider Name (Legal Business Name) : DAVID L BLOOM PA
Provider Business Mailing Address
First Line : 1430 SPRING HILL RD
Second Line : 500
City : MC LEAN
State : VA
Zip : 22102-3000
Country : US
Telephone Number : 703-287-4189
Fax Number : 703-448-1807
Provider Business Practice Location Address
First Line : 7401 FORBES BLVD STE A
Second Line :
City : SEABROOK
State : MD
Zip : 20706-2288
Country : US
Telephone Number : 301-464-6400
Fax Number : 301-464-6404
Authorized Official
Title or Position : MD
Name : DAVID L BLOOM
Credential : MD
Telephone Number : 973-707-1100
Provider Enumeration Date : 08/31/2005
Last Update Date : 07/21/2022

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Directions to “DAVID L BLOOM PA ” Practice Location

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