Healthcare Provider Details

I. General information

NPI: 1588662019
Provider Name (Legal Business Name): MARK A BLUMBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3455 MAIN ST SUITE 5
SPRINGFIELD MA
01107-1147
US

IV. Provider business mailing address

3455 MAIN ST SUITE 5
SPRINGFIELD MA
01107-1147
US

V. Phone/Fax

Practice location:
  • Phone: 413-733-9600
  • Fax: 413-732-6534
Mailing address:
  • Phone: 413-733-9600
  • Fax: 413-732-6534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number223863
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number223863
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: