MEDICARE: JOEL G BLEIER 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	207KA0200X	Allergy Physician	42472	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	042472	OTHER	MA	TUFTS HMO
2	042763605	OTHER	MA	MISC. HMO

General Provider Information

NPI Number	:	1912904624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEL G BLEIER MD

Provider Business Mailing Address
First Line	:	1 CITY HALL MALL
Second Line	:
City	:	MEDFORD
State	:	MA
Zip	:	02155-4770
Country	:	US
Telephone Number	:	781-395-2922
Fax Number	:	781-393-8905

Provider Business Practice Location Address
First Line	:	1 CITY HALL MALL
Second Line	:
City	:	MEDFORD
State	:	MA
Zip	:	02155-4770
Country	:	US
Telephone Number	:	781-395-2922
Fax Number	:	781-393-8905

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	06/04/2014

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