Healthcare Provider Details

I. General information

NPI: 1821790775
Provider Name (Legal Business Name): BLOOM HEALTHCARE LIMITED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 E MONTGOMERY AVE UNIT 111
ARDMORE PA
19003-2434
US

IV. Provider business mailing address

116 E MONTGOMERY AVE UNIT 111
ARDMORE PA
19003-2434
US

V. Phone/Fax

Practice location:
  • Phone: 610-574-2322
  • Fax:
Mailing address:
  • Phone: 610-574-2322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANTHONY RICCO
Title or Position: PHYSICIAN
Credential: MD
Phone: 610-574-2322