Provider Demographics
NPI:1033140314
Name:VALENTINA GHERGHINA MD PA
Entity Type:Organization
Organization Name:VALENTINA GHERGHINA MD PA
Other - Org Name:BLOOM MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VALENTINA
Authorized Official - Middle Name:T
Authorized Official - Last Name:GHERGHINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-737-9996
Mailing Address - Street 1:1101 N CONGRESS AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-3336
Mailing Address - Country:US
Mailing Address - Phone:561-737-9996
Mailing Address - Fax:561-737-8583
Practice Address - Street 1:1101 N CONGRESS AVE STE 100
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-3336
Practice Address - Country:US
Practice Address - Phone:561-737-9996
Practice Address - Fax:561-737-8583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70942207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL31487OtherBLUE CROSS BLUE SHIELD
FL251889900Medicaid
FLAF463Medicare PIN
FLG37700Medicare UPIN
FL251889900Medicaid