Healthcare Provider Details

I. General information

NPI: 1710042932
Provider Name (Legal Business Name): FRED BLOEM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 CONNECTICUT AVE STE 206
KENSINGTON MD
20895-3941
US

IV. Provider business mailing address

10400 CONNECTICUT AVE STE 206
KENSINGTON MD
20895-3941
US

V. Phone/Fax

Practice location:
  • Phone: 301-260-2601
  • Fax: 240-206-2740
Mailing address:
  • Phone: 301-260-2601
  • Fax: 240-206-2740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0046760
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: