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General NPI Number Information
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NPI Number | 1184780108
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Entity Type | Individual
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Provider Name | JASON DAVID BLOOM MD
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Gender | Male
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 12/09/2021
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Provider Practice Location Address
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Address Line | 2 TOWN PL STE 110
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City | BRYN MAWR
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State | PA
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Zip | 19010-3420
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Country | US
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Telephone | 610-762-5666
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Fax | 484-380-3550
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Provider Business Mailing Address
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Address Line | 2 TOWN PL STE 110
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City | BRYN MAWR
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State | PA
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Zip | 19010-3420
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Country | US
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Telephone | 610-762-5666
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Fax | 484-380-3550
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | MT186824
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number | 256050
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number | MD432401
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License Number State | PA
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