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General NPI Number Information
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NPI Number | 1811399850
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Entity Type | Individual
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Provider Name | MITCHELL BLOOM M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/22/2014
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Last Update Date | 10/29/2016
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Provider Practice Location Address
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Address Line | OAK BRANCH DRIVE SUITE 7E
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City | GREENSBORO
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State | NC
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Zip | 27407-2380
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Country | US
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Telephone | 336-405-7575
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Fax |
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Provider Business Mailing Address
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Address Line | OAK BRANCH DRIVE SUITE 7E
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City | GREENSBORO
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State | NC
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Zip | 27407-2380
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Country | US
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Telephone | 336-405-7575
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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 | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 38015
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License Number State | NC
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