Provider Demographics
NPI:1285664821
Name:BLOOM, WILLIAM S (MD)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:S
Last Name:BLOOM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03755-2053
Mailing Address - Country:US
Mailing Address - Phone:603-643-3232
Mailing Address - Fax:603-643-1877
Practice Address - Street 1:80 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:NH
Practice Address - Zip Code:03755-2053
Practice Address - Country:US
Practice Address - Phone:603-643-3232
Practice Address - Fax:603-643-1877
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0011254207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0009344Medicaid
VT0009344Medicaid
VTVN4153Medicare ID - Type Unspecified