Healthcare Provider Details

I. General information

NPI: 1093774556
Provider Name (Legal Business Name): CYNTHIA R. BLOOM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 06/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 SOUTH TAMIAMI TRAIL
SARASOTA FL
34239
US

IV. Provider business mailing address

2700 UNIVERSITY SQUARE DR
TAMPA FL
33612-5513
US

V. Phone/Fax

Practice location:
  • Phone: 941-917-1668
  • Fax: 941-917-4273
Mailing address:
  • Phone: 813-253-2721
  • Fax: 813-253-2299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME73265
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: