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NPI Code Detail

MEDICARE: DR. MITCHELL BLOOM M.D.

MEDICARE: DR. MITCHELL BLOOM 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
12081P2900XPain Medicine (Physical Medicine & Rehabilitation) Physician38015NC

General Provider Information

NPI Number : 1811399850
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MITCHELL BLOOM M.D.
Provider Business Mailing Address
First Line : OAK BRANCH DRIVE
Second Line : SUITE 7E
City : GREENSBORO
State : NC
Zip : 27407-2380
Country : US
Telephone Number : 336-405-7575
Fax Number :
Provider Business Practice Location Address
First Line : OAK BRANCH DRIVE
Second Line : SUITE 7E
City : GREENSBORO
State : NC
Zip : 27407-2380
Country : US
Telephone Number : 336-405-7575
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2014
Last Update Date : 10/29/2016

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