MEDICARE: DR. HILARY PATRICIA BLUMBERG M.D.

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
1	2084P0800X	Psychiatry Physician	036752	CT

General Provider Information

NPI Number	:	1679511299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HILARY PATRICIA BLUMBERG M.D.

Provider Business Mailing Address
First Line	:	13 ENO LN
Second Line	:
City	:	WESTPORT
State	:	CT
Zip	:	06880-6413
Country	:	US
Telephone Number	:	203-341-0498
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 GEORGE ST
Second Line	:	SUITE 901
City	:	NEW HAVEN
State	:	CT
Zip	:	06511-6624
Country	:	US
Telephone Number	:	203-785-6195
Fax Number	:	203-737-2513

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	05/01/2009

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