MEDICARE: LAURA S ROSENBAUM-BLOOM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	22334	SC
2	2084P0804X	Child & Adolescent Psychiatry Physician	22334	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	22334	OTHER	SC	MEDICAL LICENSE

General Provider Information

NPI Number	:	1396879813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA S ROSENBAUM-BLOOM M.D.

Provider Business Mailing Address
First Line	:	4101 MAIN STREET
Second Line	:	SUITE C
City	:	HILTON HEAD ISLAND
State	:	SC
Zip	:	29926
Country	:	US
Telephone Number	:	843-342-6000
Fax Number	:	843-342-6001

Provider Business Practice Location Address
First Line	:	4101 MAIN STREET
Second Line	:	SUITE C
City	:	HILTON HEAD ISLAND
State	:	SC
Zip	:	29926
Country	:	US
Telephone Number	:	843-342-6000
Fax Number	:	843-342-6001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	03/21/2012

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Directions to “ LAURA S ROSENBAUM-BLOOM M.D.” Practice Location

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