Provider Demographics
NPI:1275660680
Name:NICOLE BLOOR, M.D., P.C.
Entity Type:Organization
Organization Name:NICOLE BLOOR, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BLOOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-662-2204
Mailing Address - Street 1:727 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-2707
Mailing Address - Country:US
Mailing Address - Phone:781-662-2204
Mailing Address - Fax:781-662-2253
Practice Address - Street 1:727 MAIN ST
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-2707
Practice Address - Country:US
Practice Address - Phone:781-662-2204
Practice Address - Fax:781-662-2253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA80960207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM17510OtherBCBS
MA9700480Medicaid
MAG05234Medicare UPIN
MAM20832Medicare ID - Type Unspecified