Provider Demographics
NPI:1346469715
Name:BLOOM, EMILY FAYE (MD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:FAYE
Last Name:BLOOM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:436 N BEDFORD DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4310
Mailing Address - Country:US
Mailing Address - Phone:310-278-8811
Mailing Address - Fax:310-278-1316
Practice Address - Street 1:436 N BEDFORD DR
Practice Address - Street 2:SUITE 202
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4310
Practice Address - Country:US
Practice Address - Phone:310-278-8811
Practice Address - Fax:310-278-1316
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG38218207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1366569139OtherNPI ORGANIZATION (INC.)
WG38218AOtherPPIN
WG38218AOtherPPIN
A91974Medicare UPIN