Provider Demographics
NPI:1073190674
Name:BLOOMER, AINSLEY KATHERINE
Entity Type:Individual
Prefix:
First Name:AINSLEY
Middle Name:KATHERINE
Last Name:BLOOMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 BURLEIGH ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-3072
Mailing Address - Country:US
Mailing Address - Phone:704-618-8022
Mailing Address - Fax:
Practice Address - Street 1:1025 MOREHEAD MEDICAL DR STE 300
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2966
Practice Address - Country:US
Practice Address - Phone:704-446-2772
Practice Address - Fax:704-355-2467
Is Sole Proprietor?:No
Enumeration Date:2021-03-28
Last Update Date:2021-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCBLOO-OG8BFD207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery