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General NPI Number Information
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NPI Number | 1316492937
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Entity Type | Individual
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Provider Name | AMY SUE BLOOM M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/24/2016
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Last Update Date | 08/24/2016
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Provider Practice Location Address
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Address Line | 2100 CRYSTAL DR 10102A
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City | ARLINGTON
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State | VA
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Zip | 22202-3784
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Country | US
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Telephone | 571-551-7354
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 CRYSTAL DR 10102A
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City | ARLINGTON
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State | VA
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Zip | 22202-3784
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Country | US
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Telephone | 571-551-7354
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 170333
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License Number State | NY
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