MEDICARE: RICHARD D BLOOMBERG MD

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	208600000X	Surgery Physician	241414	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2115139	OTHER		INDEPENDENT HEALTH
2	0192612	OTHER		GHI PPO
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	241414-2W	OTHER		WORKERS COMPENSATION
5	000415467003	OTHER		BC/BS
6	P00475424	OTHER	NY	RRM
7	00028422901	OTHER		UNIVERA

General Provider Information

NPI Number	:	1770577330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD D BLOOMBERG MD

Provider Business Mailing Address
First Line	:	550 ORCHARD PARK RD
Second Line	:	A103
City	:	WEST SENECA
State	:	NY
Zip	:	14224-2646
Country	:	US
Telephone Number	:	716-677-5500
Fax Number	:	716-677-5008

Provider Business Practice Location Address
First Line	:	550 ORCHARD PARK RD
Second Line	:	A103
City	:	WEST SENECA
State	:	NY
Zip	:	14224-2646
Country	:	US
Telephone Number	:	716-677-5500
Fax Number	:	716-677-5008

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

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	12/03/2009

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Directions to “ RICHARD D BLOOMBERG MD” Practice Location

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