Provider Demographics
NPI:1548238835
Name:BLOOM, RONALD JEFFREY (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:JEFFREY
Last Name:BLOOM
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:711 COTTAGE GROVE RD
Mailing Address - Street 2:COTTAGE GROVE CARDIOLOGY
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-3060
Mailing Address - Country:US
Mailing Address - Phone:860-242-8756
Mailing Address - Fax:860-242-3052
Practice Address - Street 1:711 COTTAGE GROVE RD
Practice Address - Street 2:COTTAGE GROVE CARDIOLOGY
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-3060
Practice Address - Country:US
Practice Address - Phone:860-242-8756
Practice Address - Fax:860-242-3052
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2016-09-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT025827207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001258276Medicaid
CT060005792OtherRAILROAD MEDICARE
CT060000233OtherMEDICARE
C59509Medicare UPIN