Provider Demographics
NPI:1144613423
Name:MARTIN G. BLOOM, MD, PA
Entity Type:Organization
Organization Name:MARTIN G. BLOOM, MD, PA
Other - Org Name:THE BIOSTATION
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:BLOOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-257-2519
Mailing Address - Street 1:3100 S FEDERAL HWY
Mailing Address - Street 2:SUITE J
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-3222
Mailing Address - Country:US
Mailing Address - Phone:561-257-2519
Mailing Address - Fax:
Practice Address - Street 1:3100 S FEDERAL HWY
Practice Address - Street 2:SUITE J
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-3222
Practice Address - Country:US
Practice Address - Phone:561-257-2519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME27887332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site