Provider Demographics
NPI:1114993276
Name:RICHARD A BLOOMFIELD
Entity Type:Organization
Organization Name:RICHARD A BLOOMFIELD
Other - Org Name:NEWPORT FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLOOMFIELD
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:252-223-5054
Mailing Address - Street 1:PO BOX 969
Mailing Address - Street 2:338 HOWARD BLVD
Mailing Address - City:NEWPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28570-0969
Mailing Address - Country:US
Mailing Address - Phone:252-223-5054
Mailing Address - Fax:252-223-4038
Practice Address - Street 1:338 HOWARD BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NC
Practice Address - Zip Code:28570-0969
Practice Address - Country:US
Practice Address - Phone:252-223-5054
Practice Address - Fax:252-223-4038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-27
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC343858Medicare Oscar/Certification