Provider Demographics
NPI:1578555900
Name:BLOOM, GEORGE PETER (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:PETER
Last Name:BLOOM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 SEYMOUR ST
Mailing Address - Street 2:STE 415
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5501
Mailing Address - Country:US
Mailing Address - Phone:860-246-2071
Mailing Address - Fax:860-524-2650
Practice Address - Street 1:85 SEYMOUR ST
Practice Address - Street 2:STE 415
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5501
Practice Address - Country:US
Practice Address - Phone:860-246-2071
Practice Address - Fax:860-524-2650
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT017030208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT10676OtherHEALTH NEW ENGLAND
CT0S2059OtherHEALTH NET
CTP888862OtherOXFORD
CT070122OtherCONNECTICARE
CT4413430 003OtherCIGNA
MA6126618OtherMASSHEALTH
CT669768OtherAETNA
CT010017030CT01OtherANTHEM BCBS
CTP888862OtherOXFORD