Healthcare Provider Details

I. General information

NPI: 1063430163
Provider Name (Legal Business Name): RICHARD STEPHEN BLUMENFELD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 01/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

761 WORCESTER RD
FRAMINGHAM MA
01701-5224
US

IV. Provider business mailing address

24 NEWTON ST
SOUTHBOROUGH MA
01772-1215
US

V. Phone/Fax

Practice location:
  • Phone: 508-879-7904
  • Fax: 508-872-8594
Mailing address:
  • Phone: 508-481-5500
  • Fax: 508-460-3221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number36447
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: