Provider Demographics
NPI:1568643096
Name:BLOOM, BRADLEY J (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:J
Last Name:BLOOM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:593 EDDY ST
Mailing Address - Street 2:HASBRO 122
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4923
Mailing Address - Country:US
Mailing Address - Phone:401-444-6484
Mailing Address - Fax:401-444-6378
Practice Address - Street 1:1 HOPPIN ST
Practice Address - Street 2:CORO WEST
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4141
Practice Address - Country:US
Practice Address - Phone:401-793-8560
Practice Address - Fax:401-793-8561
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2008-02-29
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Provider Licenses
StateLicense IDTaxonomies
RIMD088852080P0216X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0216XAllopathic & Osteopathic PhysiciansPediatricsPediatric Rheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIMD08885OtherLICENSE