Provider Demographics
NPI:1184025710
Name:BLOOM, MEGAN
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:BLOOM
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 1:7461 GREENWOOD STATION RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:VA
Mailing Address - Zip Code:22943-1601
Mailing Address - Country:US
Mailing Address - Phone:434-962-5438
Mailing Address - Fax:
Practice Address - Street 1:7461 GREENWOOD STATION RD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:VA
Practice Address - Zip Code:22943-1601
Practice Address - Country:US
Practice Address - Phone:434-962-5438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula