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General NPI Number Information
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NPI Number | 1285664821
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Entity Type | Individual
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Provider Name | WILLIAM S. BLOOM MD
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Gender | Male
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 08/01/2007
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Provider Practice Location Address
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Address Line | 80 S MAIN ST
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City | HANOVER
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State | NH
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Zip | 03755-2053
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Country | US
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Telephone | 603-643-3232
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Fax | 603-643-1877
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Provider Business Mailing Address
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Address Line | 80 S MAIN ST
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City | HANOVER
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State | NH
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Zip | 03755-2053
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Country | US
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Telephone | 603-643-3232
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Fax | 603-643-1877
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 042-0011254
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License Number State | VT
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