Provider Demographics
NPI:1033554811
Name:BLOMBERG, BEN ADAM (MD)
Entity Type:Individual
Prefix:
First Name:BEN
Middle Name:ADAM
Last Name:BLOMBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6011 FARRINGTON RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-8168
Mailing Address - Country:US
Mailing Address - Phone:984-974-6599
Mailing Address - Fax:919-957-6851
Practice Address - Street 1:6011 FARRINGTON RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-8168
Practice Address - Country:US
Practice Address - Phone:984-974-6599
Practice Address - Fax:919-957-6851
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-07
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC191368390200000X
NC2016-00286207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program