Provider Demographics
NPI:1568761260
Name:BLOOMBERG, DAVID STUART
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:STUART
Last Name:BLOOMBERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 NORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-2844
Mailing Address - Country:US
Mailing Address - Phone:413-788-6544
Mailing Address - Fax:
Practice Address - Street 1:126 ISLAND POND ROAD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01118
Practice Address - Country:US
Practice Address - Phone:413-737-6294
Practice Address - Fax:413-732-0554
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15457183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist