Provider Demographics
NPI:1407864457
Name:BLOOM, ELANA J (MD)
Entity Type:Individual
Prefix:DR
First Name:ELANA
Middle Name:J
Last Name:BLOOM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 CENTRE AVE
Mailing Address - Street 2:SUITE 606
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232
Mailing Address - Country:US
Mailing Address - Phone:412-683-9422
Mailing Address - Fax:412-683-9252
Practice Address - Street 1:5200 CENTRE AVE
Practice Address - Street 2:SUITE 606
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232
Practice Address - Country:US
Practice Address - Phone:412-683-9422
Practice Address - Fax:412-683-9421
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042499E207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
5283145OtherUS HEALTHCARE CLAIMS
000538616OtherHIGHMARK
2195104OtherUS HEALTHCARE PROVIDER NO
538616OtherKEYSTONE
830002030OtherPALMETTO
PA1197840Medicaid
538616OtherFREEDOM BLUE
74205OtherAETNA
1512543OtherGATEWAY
36918OtherHEALTH AMERICA
5283145OtherAETNA CLAIMS
104346OtherUPMC FOR YOU
1197840OtherMEDICAL ASSISTANCE
538616OtherBLUE SHIELD
2195104OtherAETNA PROVIDER NUMBER
538616OtherBLUE SHIELD
5283145OtherAETNA CLAIMS