Provider Demographics
NPI:1609881317
Name:BLUMBERG, JONATHAN RAPHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:RAPHAEL
Last Name:BLUMBERG
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 1:36 SHERBURNE RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-5524
Mailing Address - Country:US
Mailing Address - Phone:781-652-8478
Mailing Address - Fax:
Practice Address - Street 1:1101 BEACON ST
Practice Address - Street 2:2 WEST
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5587
Practice Address - Country:US
Practice Address - Phone:617-731-6334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA206504207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine