Healthcare Provider Details

I. General information

NPI: 1871020347
Provider Name (Legal Business Name): BENJAMIN ARIEL BLOOM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2017
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREEN ST
BALTIMORE MD
21201
US

IV. Provider business mailing address

110 S PACA ST FL 6
BALTIMORE MD
21201-1642
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-8667
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number1021229
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: